Anti-IL-6 antibodies for the treatment of oral mucositis

ABSTRACT

The present invention is directed to therapeutic methods using IL-6 antagonists such as anti-IL-6 antibodies and fragments thereof having binding specificity for IL-6 to prevent or treat mucositis (e.g., oral mucositis) including persons on a treatment regimen with a drug or chemotherapy and/or radiation for cancer (e.g., head and neck cancer) that is associated with increased risk of mucositis, including oral mucositis.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent application claims priority to U.S. Provisional PatentApplication No. 61/416,332, filed Nov. 23, 2010; U.S. Provisional PatentApplication No. 61/416,343, filed Nov. 23, 2010; U.S. Provisional PatentApplication No. 61/416,351, filed Nov. 23, 2010; U.S. Provisional PatentApplication No. 61/416,363, filed Nov. 23, 2010; U.S. Provisional PatentApplication No. 61/511,797, filed Jul. 26, 2011; and U.S. ProvisionalPatent Application No. 61/489,857, filed May 25, 2011, the disclosuresof each of which are herein incorporated by reference in their entirety.

FIELD OF THE INVENTION

IL-6 antagonists, including anti-IL-6 antibodies and antibody fragmentsthereof, may be used to reduce C-reactive protein (“CRP levels”) andinflammation and in methods and compositions for the treatment andprevention of mucositis, including oral, alimentary, andgastrointestinal tract mucositis.

BACKGROUND OF THE INVENTION

Interleukin-6 (IL-6)

Interleukin-6 (“IL-6”) is a multifunctional cytokine involved innumerous biological processes such as the regulation of the acuteinflammatory response, the modulation of specific immune responsesincluding B- and T-cell differentiation, bone metabolism,thrombopoiesis, epidermal proliferation, menses, neuronal celldifferentiation, neuroprotection, aging, cancer, and the inflammatoryreaction occurring in Alzheimer's disease. See Papassotiropoulos, et al.(2001) Neurobiology of Aging 22: 863-871.

IL-6 is a member of a family of cytokines that promote cellularresponses through a receptor complex consisting of at least one subunitof the signal-transducing glycoprotein gp130 and the IL-6 receptor(“IL-6R”) (also known as gp80). The IL-6R may also be present in asoluble form (“sIL-6R”). IL-6 binds to IL-6R, which then dimerizes thesignal-transducing receptor gp130. See Jones (2005) Immunology 175:3463-3468.

IL-6 is a pleiotropic pro-inflammatory cytokine, which regulates theacute phase response and the transition from the innate to the adaptiveimmune response. IL-6 increases hepatic synthesis of proteins that areinvolved in the ‘acute phase response’ leading to symptoms such asfever, chills, and fatigue. It stimulates B cell differentiation andsecretion of antibodies and prevents apoptosis of activated B cells.IL-6 activates and induces proliferation of T cells and in the presenceof IL-2, induces differentiation of mature and immature CD8 T cells intocytotoxic T cells. IL-6 is also involved in the differentiation of Th17cells and IL-17 production and inhibits regulatory T cells (Treg)differentiation. IL-6 also activates osteoclasts, synoviocytes,neutrophils, and other hematopoietic cells. Park, et al. (2007) Bulletinof the NYU Hospital for Joint Diseases 65 (suppl 1): S4-10; Guerne, etal. (1989) J Clin Invest. 83(2): 585-92; Houssiau, et al. (1988)Arthritis Rheum. 31(6): 784-8; Nishimotor, et al. (2006) Nat Clin PractRheumatol. 2(11): 619-26; Kishimoto (1989) Blood 74(1): 1-10; and VanSnick (1990) Annu Rev Immunol. 8: 253-78.

In humans, the gene encoding IL-6 is organized in five exons and fourintrons, and maps to the short arm of chromosome 7 at 7p21. Translationof IL-6 RNA and post-translational processing result in the formation ofa 21 to 28 kDa protein with 184 amino acids in its mature form. SeePapassotiropoulos, et al. (2001) Neurobiology of Aging 22:863-871.

The function of IL-6 is not restricted to the immune response as it actsin hematopoiesis, thrombopoiesis, osteoclast formation, elicitation ofhepatic acute phase response resulting in the elevation of C-reactiveprotein (CRP) and serum amyloid A (SAA) protein. It is known to be agrowth factor for epidermal keratinocytes, renal mesangial cells,myeloma and plasmacytoma cells. Grossman, et al. (1989) Prot Natl AcadSci. 86(16): 6367-6371; Horii, et al. (1989) J Immunol. 143(12):3949-3955; and Kawano, et al. (1988) Nature 332: 83-85. IL-6 is producedby a wide range of cell types including monocytes/macrophages,fibroblasts, epidermal keratinocytes, vascular endothelial cells, renalmessangial cells, glial cells, condrocytes, T and B-cells and some tumorcells. Akira, et al. (1990) FASEB J. 4(11): 2860-2867. Except for tumorcells that constitutively produce IL-6, normal cells do not express IL-6unless appropriately stimulated.

Elevated IL-6 levels have been observed in many types of cancer,including breast cancer, leukemia, ovarian cancer, prostate cancer,pancreatic cancer, lymphoma, lung cancer, renal cell carcinoma,colorectal cancer, and multiple myeloma. See, e.g., Chopra, et al.(2004) MJAF 160:45-49; Songur, et al. (2004) Tumori 90:196-200; Slay, etal. (1992) Cancer Research 52: 3317-3322; Nikiteas, et al. (2005) WorldJ. Gasterenterol. 11:1639-1643; reviewed in Heikkila, et al. (2008) EurJ Cancer 44:937-945. Clinical studies (reviewed in Trikha, et al. (2003)Clinical Cancer Research 9: 4653-4665) have shown some improvement inpatient outcomes due to administration of various anti-IL-6 antibodies,particularly in those cancers in which IL-6 plays a direct rolepromoting cancer cell proliferation or survival.

As noted above, IL-6 stimulates the hepatic acute phase response,resulting in increased production of CRP and elevated serum CRP levels.For this reason, C-reactive protein (CRP) has been reported to comprisea surrogate marker of IL-6 activity. Thus, elevated IL-6 activity can bedetected through measurement of serum CRP. Conversely, effectivesuppression of IL-6 activity, e.g., through administration of aneutralizing anti-IL-6 antibody, can be detected by the resultingdecrease in serum CRP levels.

IL-6 is believed to play a role in the development of a multitude ofdiseases and disorders, including but not limited to fatigue, cachexia,autoimmune diseases, diseases of the skeletal system, cancer, heartdisease, obesity, diabetes, asthma, Alzheimer's disease and multiplesclerosis. See, e.g., WO 2011/066374, WO 2011/066371, WO 2011/066378,and WO 2011/066369.

A recent clinical trial demonstrated that administration of rosuvastatinto apparently healthy individuals having elevated CRP (greater than 2.0mg/l) reduced their CRP levels by 37% and greatly decreased theincidence of myocardial infarction, stroke, arterial revascularization,hospitalization for unstable angina, or death from cardiovascularcauses. Ridker et al., N Engl J Med. 2008 Nov. 9 [ Epub ahead of print].

In addition to its direct role in pathogenesis of some cancers and otherdiseases, chronically elevated IL-6 levels appear to adversely affectpatient well-being and quality of life. For example, elevated IL-6levels have been reported to be associated with cachexia and fever, andreduced serum albumin. Gauldie, et al. (1987) PNAS 84: 7251-7253;Heinric, et al. (1990) Biochem J. 265(3): 621-636; Zamir, et al. (1993)Metabolism 42: 204-208; Zamir, et al. (1992) Arch Surg 127: 170-174.Inhibition of IL-6 by a neutralizing antibody has been reported toameliorate fever and cachexia in cancer patients, though improvement inthese patients' serum albumin level has not been reported. Emilie, etal. (1994) Blood 84: 2472-2479; Blay, et (1992) Cancer Research 52:3317-3322; Bataille, et al. (1995) Blood 86: 685-691.

Mucositis

Mucositis is the painful inflammation and ulceration of the mucousmembranes lining the digestive tract, usually as an adverse effect ofchemotherapy and radiotherapy treatment for cancer. Ridge, et al. “Headand Neck Tumors” in Pazdur R, Wagman L D, Camphausen K A, Hoskins W J(Eds) Cancer Management: A Multidisciplinary Approach. [11 Ed.] (2008).Mucositis can occur anywhere along the gastrointestinal (GI) tract. Oralmucositis is marked by inflammation and ulceration in the mouth and is acommon and often debilitating complication of cancer treatment. Sonis(2004) J Supportive Oncology 2(Suppl 3): 3-8.

Oral and gastrointestinal mucositis is a toxicity of many forms ofradiotherapy and chemotherapy. It has a significant impact on health,quality of life and economic outcomes that are associated withtreatment. It also indirectly affects the success of antineoplastictherapy by limiting the ability of patients to tolerate optimaltumoricidal treatment. The complex pathogenesis of mucositis has onlyrecently been appreciated and reflects the dynamic interactions of allof the cells and tissue types that comprise the epithelium andsubmucosa. The identification of the molecular events that lead totreatment-induced mucosal injury has provided targets formechanistically based interventions to prevent and treat mucositis.

Historically, mucositis was thought to arise solely as a consequence ofepithelial injury. It was hypothesized that radiation or chemotherapynonspecifically targeted the rapidly proliferating cells of the basalepithelium, causing the loss of the ability of the tissue to renewitself. The atrophy, thinning and ulceration of the mucosal epitheliumthat is associated with mucositis was thought to be a consequence ofthese events. Furthermore, it was believed that the process wasfacilitated by trauma and oral microorganisms.

Radiation-induced mucositis was typically recognized as an ‘outside-in’process, in which DNA strand breaks occurred in oral basal-epithelialcells. Chemotherapy-induced mucositis has mainly been attributed tobasal-cell damage that results when drugs permeate to these cells fromthe submucosal blood supply. A role for saliva-borne chemotherapeuticagents in the induction of mucositis has been also been proposed, butnot proven. Chemotherapy-induced mucositis can be further compounded byconcomitant myelosuppression.

Radiation- or chemotherapy-induced mucositis is initiated by directinjury to basal epithelial cells and cells in the underlying tissue.DNA-strand breaks can result in cell death or injury. Non-DNA injury isinitiated through a variety of mechanisms, some of which are mediated bythe generation of reactive oxygen species. Radiation and chemotherapyare effective activators of several injury-producing pathways inendothelia, fibroblasts and epithelia. In these cells, the activation oftranscription factors such as nuclear factor-κB (NF-κB) and NRF2 leadsto the upregulation of genes that modulate the damage response. Immunecells (macrophages) produce pro-inflammatory cytokines, such astumour-necrosis factor-α (TNF-α) and interleukin 6, which causes furthertissue injury. These signaling molecules also participate in apositive-feedback loop that amplifies the original effects of radiationand chemotherapy. For example, TNF-α activates NF-κB andsphingomyelinase activity in the mucosa, leading to more cell death. Inaddition, direct and indirect damage to epithelial stem cells results ina loss of renewal capacity. As a result, the epithelium begins to thinand patients start to experience the early symptoms of mucositis.

Mucositis is observed during chemotherapeutic or radiation treatment ofmany different cancers including head and neck cancer, multiple myeloma,colorectal cancers, Because of the problems caused by mucositis whichmay preclude further radiation or chemotherapy and also impede nutritionbecause of the discomfort caused by mucositis during swallowing anddigestion

The most common symptoms of mucositis include redness, dryness, orswelling of the mouth, burning or discomfort when eating or drinking,open sores in the mouth and throat, abdominal cramps, and tenderness orrectal redness or ulcers. Essentially mucositis involves theinflammation of the lining of the mouth and digestive tract, andfrequently occurs in cancer patients after chemotherapy and radiationtherapy. The cheek, gums, soft plate, oropharynx, top and sides oftongue, and floor of the mouth may be affected, as well as the esophagusand rectal areas. Along with redness and swelling, patients typicallyexperience a strong, burning pain.

Oral and gastrointestinal (GI) mucositis can affect up to 100% ofpatients undergoing high-dose chemotherapy and hematopoietic stem celltransplantation (HSCT), 80% of patients with malignancies of the headand neck receiving radiotherapy, and a wide range of patients receivingchemotherapy. Alimentary tract mucositis increases mortality andmorbidity and contributes to rising health care costs. Rubenstein, etal. (2004) Cancer 100(9 Suppl): 2026-46.

For most cancer treatment, about 5-15% of patients get mucositis.However, with 5-fluorouracil (5-FU), up to 40% get mucositis, and 10-15%get grade 3-4 oral mucositis. Irinotecan is associated with severe GImucositis in over 20% of patients. 75-85% of bone marrow transplantationrecipients experience mucositis, of which oral mucositis is the mostcommon and most debilitating, especially when melphalan is used. Ingrade 3 oral mucositis, the patient is unable to eat solid food, and ingrade 4, the patient is unable to consume liquids as well. Rubenstein,et al., (2004) Cancer 100(9 Suppl): 2026-46.

Radiotherapy to the head and neck or to the pelvis or abdomen isassociated with Grade 3 and Grade 4 oral or GI mucositis, respectively,often exceeding 50% of patients. Among patients undergoing head and neckradiotherapy, pain and decreased oral function may persist long afterthe conclusion of therapy. Fractionated radiation dosage increases therisk of mucositis to >70% of patients in most trials. Oral mucositis isparticularly profound and prolonged among HSCT recipients who receivetotal-body irradiation. Rubenstein, et al., (2004) Cancer 100(9 Suppl):2026-46.

Although there are factors that increase the likelihood and severity ofmucositis, there is no reliable manner to predict who will be affected.Not only is mucositis more common in elderly patients, the degree ofbreakdown is often more debilitating. The severity of mucositis tends tobe increased if a patient exercises poor oral hygiene or has acompromised nutritional status. A preexisting infection or irritation tothe mucous membrane may also result in a more severe case of mucositis.

The types of drug used to treat cancer and the schedule by which theyare given may influence the risk of developing mucositis. Doxorubicinand methotrexate, for example, frequently cause mucositis. Thechemotherapy agent fluorouracil does not usually severely affect themucous membranes when administered in small doses over continuousintravenous (IV) infusion. When the schedule is adjusted so that ahigher dose is given over a shorter period of time (typically over fivedays), fluorouracil can cause very severe, painful, dose-limiting casesof mucositis. Patients undergoing treatment with high-dose chemotherapyand bone marrow rescue often develop mucositis.

In addition, mucositis also tends to develop in radiation therapyadministered to the oral cavity, or in dosages that exceed 180 cGy perday over a five-day period. Combination therapy, either multiplechemotherapy agents or chemotherapy and radiation therapy to the oralcavity, can increase the incidence of mucositis.

Currently there is no real cure for mucositis, treatment is aimed atprevention and management of symptoms. Mucositis typically resolves afew weeks after treatment as the cells regenerate, and treatmentcessation is only occasionally required. In some cases, drug therapywill be altered so that a less toxic agent is given.

Patients at risk for mucositis should be meticulous about their oralhygiene, brushing frequently with a soft toothbrush and flossingcarefully with unwaxed dental floss. If bleeding of the gums develops,patients should replace their toothbrushes with soft toothettes orgauze. Dentures should also be cleaned regularly. Patients should bewell-hydrated, drinking fluids frequently and rinsing the mouth severaltimes a day. Mouthwashes that contain alcohol or hydrogen peroxideshould be avoided as they may dry out the mouth and increase pain. Lipsshould also be kept moist. Physical irritation to the mouth should beavoided. If time permits, dental problems, such as cavities orill-fitting dentures, should be resolved with a dentist prior tobeginning cancer treatment. Patients are generally more comfortableeating mild, medium-temperature foods. Spicy, acidic, very hot or verycold foods can irritate the mucosa. Tobacco and alcohol should also beavoided.

Hospital personnel and the patients themselves should inspect the mouthfrequently to look for signs and symptoms of mucositis. Evidence ofmucositis (inflammation, white or yellow shiny mucous membranesdeveloping into red, raw, painful membranes) may be present as early asfour days after chemotherapy administration. Sodium bicarbonate mouthrinses are sometimes used to decrease the amount of oral flora andpromote comfort, though there is no scientific evidence that this isbeneficial. Typically, patients will rinse every few hours with asolution containing ½ teaspoon (tsp) salt and ½ tsp baking soda in onecup of water.

Pain relief is often required in patients with mucositis. In some cases,rinsing with a mixture of maalox, xylocalne, and diphenhydraminehydrochloride relieves pain. However, because of xylocalne's numbingeffects, taste sensation may be altered. Worse, it may reduce the body'snatural gag reflex, possibly causing problems with swallowing. Coatingagents such as kaopectate and aluminum hydroxide gel may also helprelieve symptoms. Rinsing with benzydamine has also shown promise, notonly in managing pain, but also in preventing the development ofmucositis. More severe pain may require liquid Tylenol with codeine, oreven intravenous opioid drugs. Patients with severe pain may not be ableto eat, and may also require nutritional supplements through an I.V.(intravenous line).

A treatment called cryotherapy has shown promise in patients beingtreated with fluorouracil administered in the aforementioned five-day,high-dose schedule. Patients continuously swish ice chips in their mouthduring the thirty-minute infusion of the drug, causing the blood vesselsto constrict, thereby reducing the drug's ability to affect the oralmucosa.

Chamomile and allopurinol mouthwashes have been tried in the past tomanage mucositis, but studies have found them to be ineffective.Biologic response modifiers are being evaluated to determine theirpossible role in managing mucositis. Recent studies using topicalantimicrobial lozenges have shown promise as well, but more research isneeded. Patients with multiple myeloma receiving chemotherapy(dexamethasone and melphelan) and autologous stem cell transplantation(ASCT) who were in addition administered an anti-IL-6 antibody (BE8) hadreduced CRP levels and a significant reduction in fever as well asreduced onset and severity of mucositis. Rossi, et al. (2005) BoneMarrow Transplantation 36: 771-779. Particularly, the mucositis in thetreated patients was a lower grade of toxicity requiring no morphineinfusion as compared to patients not receiving the anti-IL-6 antibody.Also, gastrointestinal mucositis symptoms such as diarrhea were reducedand quality of life was improved as evidenced by better oral intake ofnutrition and daily activity.

Therefore, there is a strong need in the art for improved methods oftreating and preventing mucositis, both oral and gastrointestinalmucositis, as this condition compromises the efficacy of chemotherapy orradiation cancer treatments as well as adversely affecting the qualityof life of cancer patients because of the extreme pain and discomfortcaused by this condition. The invention described herein providescompositions comprising anti-IL-6 antibodies and antibody fragmentsthereof, and methods of use which may be used to treat IL-6 relatedconditions.

SUMMARY OF THE INVENTION

The present invention provides compositions comprising IL-6 antagonistsand methods of use thereof for treating mucositis. In one embodiment,the mucositis may be oral, gastrointestinal, or alimentary mucositis. Inanother embodiment, the mucositis may be associated with cancer,chemotherapy, radiotherapy, or the combination of chemotherapy andradiotherapy. In one embodiment of the invention, the IL-6 antagonistmay target IL-6, IL-6 receptor alpha, gp130, p38 MAP kinase, JAK1, JAK2,JAK3, STAT3, SYK, or any combination thereof. In one embodiment of theinvention, the IL-6 antagonist may be an antibody, an antibody fragment,a peptide, a glycoalkoid, an antisense nucleic acid, a ribozyme, aretinoid, an avemir, a small molecule, or any combination thereof. Inone embodiment of the invention, the IL-6 antagonist may be ananti-IL-6R, anti-gp130, anti-p38 MAP kinase, anti-JAK1, anti-JAK2,anti-JAK3, anti-STAT3, or anti-SYK antibody or antibody fragment. In oneembodiment of the invention, the IL-6 antagonist may be a small moleculecomprising thalidomide, lenalidomide, or any combination thereof. In oneembodiment of the invention, the IL-6 antagonist may be is an anti-IL-6antibody or antibody fragment.

The present invention provides compositions comprising humanizedmonoclonal antibodies that selectively bind IL-6 and methods of treatingmucositis. In one embodiment, anti-IL-6 antibodies (e.g., ALD518antibodies, also known as Ab1) may be used in methods for the treatmentof mucositis. In this embodiment of the invention anti-IL-6 antibody orantibody fragment may be administered prophylactically to patients atsignificant risk of developing mucositis. The invention also providesfor humanized monoclonal anti-IL-6 antibodies may be used in thetreatment of mucositis. The present invention further includes theprevention or treatment of inflammatory conditions by administration ofanti-IL-6 antibodies according to the invention.

In one embodiment, the invention provides for a method of treating orpreventing mucositis comprising administration of a compositioncomprising an effective amount of an IL-6 antagonist. In anotherembodiment, a method of treating or preventing oral mucositis maycomprise administration of a composition comprising an effective amountof an IL-6 antagonist. In another embodiment, a method of treating orpreventing alimentary tract mucositis may comprise administration of acomposition comprising an effective amount of an IL-6 antagonist. Inanother embodiment, a method of treating or preventing gastrointestinaltract mucositis may comprise administration of a composition comprisingan effective amount of an IL-6 antagonist.

In one embodiment, the method of treating or preventing mucositisassociated with chemotherapy may comprise administration of acomposition comprising an effective amount of an IL-6 antagonist. Inanother embodiment, a method of treating or preventing oral mucositisassociated with chemotherapy may comprise administration of acomposition comprising an effective amount of an IL-6 antagonist. Inanother embodiment, a method of treating or preventing alimentary tractmucositis associated with chemotherapy may comprise administration of acomposition comprising an effective amount of an IL-6 antagonist. Inanother embodiment, a method of treating or preventing gastrointestinaltract mucositis associated with chemotherapy may comprise administrationof a composition comprising an effective amount of an IL-6 antagonist.

In one embodiment, the method of treating or preventing mucositisassociated with radiotherapy may comprise administration of acomposition comprising an effective amount of an IL-6 antagonist. Inanother embodiment, a method of treating or preventing oral mucositisassociated with radiotherapy may comprise administration of acomposition comprising an effective amount of an IL-6 antagonist. Inanother embodiment, a method of treating or preventing alimentary tractmucositis associated with radiotherapy may comprise administration of acomposition comprising an effective amount of an IL-6 antagonist. Inanother embodiment, a method of treating or preventing gastrointestinaltract mucositis associated with radiotherapy may comprise administrationof a composition comprising an effective amount of an IL-6 antagonist.

In one embodiment, the method of treating or preventing mucositisassociated with cancer may comprise administration of a compositioncomprising an effective amount of an IL-6 antagonist. In anotherembodiment, a method of treating or preventing oral mucositis associatedwith cancer may comprise administration of a composition comprising aneffective amount of an IL-6 antagonist. In another embodiment, a methodof treating or preventing alimentary tract mucositis associated withcancer may comprise administration of a composition comprising aneffective amount of an IL-6 antagonist. In another embodiment, a methodof treating or preventing gastrointestinal tract mucositis associatedwith cancer may comprise administration of a composition comprising aneffective amount of an IL-6 antagonist.

In one embodiment, the method of treating or preventing mucositisassociated with hematopoietic stem cell transplant (HSCT) may compriseadministration of a composition comprising an effective amount of anIL-6 antagonist. In another embodiment, a method of treating orpreventing oral mucositis associated with hematopoietic stem celltransplant (HSCT) may comprise administration of a compositioncomprising an effective amount of an IL-6 antagonist. In anotherembodiment, a method of treating or preventing alimentary tractmucositis associated with hematopoietic stem cell transplant (HSCT) maycomprise administration of a composition comprising an effective amountof an IL-6 antagonist. In another embodiment, a method of treating orpreventing gastrointestinal tract mucositis associated withhematopoietic stem cell transplant (HSCT) may comprise administration ofa composition comprising an effective amount of an IL-6 antagonist.

In one embodiment, the method of treating or preventing diarrhea maycomprise administration of a composition comprising an effective amountof an IL-6 antagonist. In another embodiment, a method of treating orpreventing diarrhea associated with chemotherapy may compriseadministration of a composition comprising an effective amount of anIL-6 antagonist, another embodiment, a method of treating or preventingdiarrhea associated with radiotherapy may comprise administration of acomposition comprising an effective amount of an IL-6 antagonist. Inanother embodiment, a method of treating or preventing diarrheaassociated with hematopoietic stem cell transplant (HSCT) may compriseadministration of a composition comprising an effective amount of anIL-6 antagonist.

In one embodiment, the method of treating or preventing emesis maycomprise administration of a composition comprising an effective amountof an IL-6 antagonist. In another embodiment, a method of treating orpreventing emesis associated with chemotherapy may compriseadministration of a composition comprising an effective amount of anIL-6 antagonist. In another embodiment, a method of treating orpreventing emesis associated with radiotherapy may compriseadministration of a composition comprising an effective amount of anIL-6 antagonist. In another embodiment, a method of treating orpreventing emesis associated with hematopoietic stem cell transplant(HSCT) may comprise administration of a composition comprising aneffective amount of an IL-6 antagonist.

In one embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of mucositis. In further embodiment, the invention providesfor the use of an IL-6 antagonist in the manufacture of a medicament forthe treatment or prevention of oral mucositis. In further embodiment,the invention provides for the use of an IL-6 antagonist in themanufacture of a medicament for the treatment or prevention ofalimentary tract mucositis. In further embodiment, the inventionprovides for the use of an IL-6 antagonist in the manufacture of amedicament for the treatment or prevention of gastrointestinal tractmucositis.

In one embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of mucositis associated with chemotherapy. In furtherembodiment, the invention provides for the use of an IL-6 antagonist inthe manufacture of a medicament for the treatment or prevention of oralmucositis associated with chemotherapy. In further embodiment, theinvention provides for the use of an IL-6 antagonist in the manufactureof a medicament for the treatment or prevention of alimentary tractmucositis associated with chemotherapy. In further embodiment, theinvention provides for the use of an IL-6 antagonist in the manufactureof a medicament for the treatment or prevention of gastrointestinaltract mucositis associated with chemotherapy

In one embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of mucositis associated with radiotherapy. In furtherembodiment, the invention provides for the use of an IL-6 antagonist inthe manufacture of a medicament for the treatment or prevention of oralmucositis associated with radiotherapy. In further embodiment, theinvention provides for the use of an IL-6 antagonist in the manufactureof a medicament for the treatment or prevention of alimentary tractmucositis associated with radiotherapy. In further embodiment, theinvention provides for the use of an IL-6 antagonist in the manufactureof a medicament for the treatment or prevention of gastrointestinaltract mucositis associated with radiotherapy.

In one embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of mucositis associated with cancer. In further embodiment,the invention provides for the use of an IL-6 antagonist in themanufacture of a medicament for the treatment or prevention of oralmucositis associated with cancer. In further embodiment, the inventionprovides for the use of an IL-6 antagonist in the manufacture of amedicament for the treatment or prevention of alimentary tract mucositisassociated with cancer. In further embodiment, the invention providesfor the use of an IL-6 antagonist in the manufacture of a medicament forthe treatment or prevention of gastrointestinal tract mucositisassociated with cancer.

In one embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of mucositis associated with hematopoietic stem celltransplant (HSCT). In further embodiment, the invention provides for theuse of an IL-6 antagonist in the manufacture of a medicament for thetreatment or prevention of oral mucositis hematopoietic stem celltransplant (HSCT). In further embodiment, the invention provides for theuse of an IL-6 antagonist in the manufacture of a medicament for thetreatment or prevention of alimentary tract mucositis hematopoietic stemcell transplant (HSCT). In further embodiment, the invention providesfor the use of an IL-6 antagonist in the manufacture of a medicament forthe treatment or prevention of gastrointestinal tract mucositishematopoietic stem cell transplant (HSCT).

In one embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of diarrhea. In further embodiment, the invention providesfor the use of an IL-6 antagonist in the manufacture of a medicament forthe treatment or prevention of diarrhea associated with chemotherapy. Infurther embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of diarrhea associated with radiotherapy. In furtherembodiment, the invention provides for the use of an IL-6 antagonist inthe manufacture of a medicament for the treatment or prevention ofdiarrhea associated with hematopoietic stem cell transplant (HSCT).

In one embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of emesis. In further embodiment, the invention provides forthe use of an IL-6 antagonist in the manufacture of a medicament for thetreatment or prevention of emesis associated with chemotherapy. Infurther embodiment, the invention provides for the use of an IL-6antagonist in the manufacture of a medicament for the treatment orprevention of emesis associated with radiotherapy. In furtherembodiment, the invention provides for the use of an IL-6 antagonist inthe manufacture of a medicament for the treatment or prevention ofemesis associated with hematopoietic stem cell transplant (HSCT).

The invention provides a method of treating or preventing mucositiscomprising administration of a composition comprising an effectiveamount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11,Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23,Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35,or Ab36 antibody, or an antibody fragment thereof, to a subject in needthereof, wherein the antibody, or antibody fragment thereof,specifically binds to IL-6.

The invention also provides a method of treating mucositis comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention further provides a method of preventing mucositiscomprising administration of a composition comprising an effectiveamount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11,Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23,Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35,or Ab36 antibody, or an antibody fragment thereof, to a subject in needthereof, wherein the antibody, or antibody fragment thereof,specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofmucositis comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5,Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention also provides a composition for the treatment of mucositiscomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofmucositis comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5,Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention provides a composition comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides for a pharmaceutical composition comprisingan effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of mucositis. In a further embodiment,said composition may be formulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of mucositis. In a further embodiment, saidcomposition may be formulated for subcutaneous administration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of mucositis. In a further embodiment, saidcomposition may be formulated for subcutaneous administration.

The invention provides a method of treating or preventing mucositiscomprising administration of a composition comprising an effectiveamount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11,Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23,Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35,or Ab36 antibody, or an antibody fragment thereof, to a subject in needthereof, wherein the antibody, or antibody fragment thereof,specifically binds to IL-6.

The invention also provides a method of treating oral mucositiscomprising administration of a composition comprising an effectiveamount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11,Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23,Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35,or Ab36 antibody, or an antibody fragment thereof, to a subject in needthereof, wherein the antibody, or antibody fragment thereof,specifically binds to IL-6.

The invention further provides a method of preventing oral mucositiscomprising administration of a composition comprising an effectiveamount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11,Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23,Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35,or Ab36 antibody, or an antibody fragment thereof, to a subject in needthereof, wherein the antibody, or antibody fragment thereof,specifically binds to IL-6.

The invention provides a composition for the treatment or prevention oforal mucositis comprising an effective amount of an Ab1, Ab2, Ab3, Ab4,Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention also provides a composition for the treatment of oralmucositis comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5,Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention of oralmucositis comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5,Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of oral mucositis. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of oral mucositis. In a further embodiment, saidcomposition may be formulated for subcutaneous administration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of oral mucositis. In a further embodiment, saidcomposition may be formulated for subcutaneous administration.

The invention provides a method of treating or preventinggastrointestinal tract mucositis comprising administration of acomposition comprising an effective amount of an Ab1, Ab2, Ab3, Ab4,Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention also provides a method of treating gastrointestinal tractmucositis comprising administration of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a method of preventing gastrointestinaltract mucositis comprising administration of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofgastrointestinal tract mucositis comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a composition for the treatment ofgastrointestinal tract mucositis comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention further provides a composition for the prevention ofgastrointestinal tract mucositis comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of gastrointestinal tract mucositis. Ina further embodiment, said composition may be formulated forsubcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of gastrointestinal tract mucositis. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of gastrointestinal tract mucositis. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides a method of treating or preventing alimentarytract mucositis comprising administration of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention also provides a method of treating alimentary tractmucositis comprising administration of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a method of preventing alimentary tractmucositis comprising administration of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofalimentary tract mucositis comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention also provides a composition for the treatment ofalimentary tract mucositis comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofalimentary tract mucositis comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of alimentary tract mucositis. In afurther embodiment, said composition may be formulated for subcutaneousadministration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of alimentary tract mucositis. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of alimentary tract mucositis. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides a method of treating or preventing mucositisassociated with chemotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a method of treating mucositis associatedwith chemotherapy comprising administration of a composition comprisingan effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a method of preventing mucositisassociated with chemotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofmucositis associated with chemotherapy comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab2, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a composition for the treatment of mucositisassociated with chemotherapy comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofmucositis associated with chemotherapy comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of mucositis associated withchemotherapy. In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of mucositis associated with chemotherapy. In afurther embodiment, said composition may be formulated for subcutaneousadministration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of mucositis associated with chemotherapy. In afurther embodiment, said composition may be formulated for subcutaneousadministration.

The invention provides a method of treating or preventing mucositisassociated with radiotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a method of treating mucositis associatedwith radiotherapy comprising administration of a composition comprisingan effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a method of preventing mucositisassociated with radiotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofmucositis associated with radiotherapy comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a composition for the treatment of mucositisassociated with radiotherapy comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofmucositis associated with radiotherapy comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of mucositis associated withradiotherapy. In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of mucositis associated with radiotherapy. In afurther embodiment, said composition may be formulated for subcutaneousadministration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of mucositis associated with radiotherapy. In afurther embodiment, said composition may be formulated for subcutaneousadministration.

The invention provides a method of treating or preventing mucositisassociated with hematopoietic stem cell transplant (HSCT) comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a method of treating mucositis associatedwith hematopoietic stem cell transplant (HSCT) comprising administrationof a composition comprising an effective amount of an Ab1, Ab2, Ab3,Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16,Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28,Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or anantibody fragment thereof, to a subject in need thereof, wherein theantibody, or antibody fragment thereof, specifically binds to IL-6.

The invention further provides a method of preventing mucositisassociated with hematopoietic stem cell transplant (HSCT) comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides a composition for the treatment or prevention ofmucositis associated with hematopoietic stem cell transplant (HSCT)comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a composition for the treatment of mucositisassociated with hematopoietic stem cell transplant (HSCT) comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofmucositis associated with hematopoietic stem cell transplant (HSCT)comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of mucositis associated withhematopoietic stem cell transplant (HSCT). In a further embodiment, saidcomposition may be formulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of mucositis associated with hematopoietic stem celltransplant (HSCT). In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of mucositis associated with hematopoietic stem celltransplant (HSCT). In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention provides a method of treating or preventing diarrheacomprising administration of a composition comprising an effectiveamount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11,Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23,Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35,or Ab36 antibody, or an antibody fragment thereof, to a subject in needthereof, wherein the antibody, or antibody fragment thereof,specifically binds to IL-6.

The invention also provides a method of treating diarrhea comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention further provides a method of preventing diarrheacomprising administration of a composition comprising an effectiveamount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11,Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23,Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35,or Ab36 antibody, or an antibody fragment thereof, to a subject in needthereof, wherein the antibody, or antibody fragment thereof,specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofdiarrhea comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5,Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention also provides a composition for the treatment of diarrheacomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofdiarrhea comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5,Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of diarrhea. In a further embodiment,said composition may be formulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of diarrhea. In a further embodiment, said compositionmay be formulated for subcutaneous administration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to 1′-6, for the manufacture of a medicamentfor the prevention of diarrhea. In a further embodiment, saidcomposition may be formulated for subcutaneous administration.

The invention provides a method of treating or preventing diarrheaassociated with chemotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a method of treating diarrhea associatedwith chemotherapy comprising administration of a composition comprisingan effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a method of preventing diarrheaassociated with chemotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofdiarrhea associated with chemotherapy comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a composition for the treatment of diarrheaassociated with chemotherapy comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofdiarrhea associated with chemotherapy comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of diarrhea associated withchemotherapy. In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of diarrhea associated with chemotherapy. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of diarrhea associated with chemotherapy. In afurther embodiment, said composition may be formulated for subcutaneousadministration.

The invention provides a method of treating or preventing diarrheaassociated with radiotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a method of treating diarrhea associatedwith radiotherapy comprising administration of a composition comprisingan effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a method of preventing diarrheaassociated with radiotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofdiarrhea associated with radiotherapy comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a composition for the treatment of diarrheaassociated with radiotherapy comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofdiarrhea associated with radiotherapy comprising an effective amount ofan Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of diarrhea associated withradiotherapy. In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of diarrhea associated with radiotherapy. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of diarrhea associated with radiotherapy. In afurther embodiment, said composition may be formulated for subcutaneousadministration.

The invention provides a method of treating or preventing diarrheaassociated with hematopoietic stem cell transplant (HSCT). comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a method of treating diarrhea associatedwith hematopoietic stem cell transplant (HSCT). comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention further provides a method of preventing diarrheaassociated with hematopoietic stem cell transplant (HSCT). comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides a composition for the treatment or prevention ofdiarrhea associated with hematopoietic stem cell transplant (HSCT).comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a composition for the treatment of diarrheaassociated with hematopoietic stem cell transplant (HSCT). comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofdiarrhea associated with hematopoietic stem cell transplant (HSCT).comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of diarrhea associated withhematopoietic stem cell transplant (HSCT). In a further embodiment, saidcomposition may be formulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of diarrhea associated with hematopoietic stem celltransplant (HSCT). In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of diarrhea associated with hematopoietic stem celltransplant (HSCT). In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention provides a method of treating or preventing emesiscomprising administration of a composition comprising an effectiveamount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11,Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23,Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35,or Ab36 antibody, or an antibody fragment thereof, to a subject in needthereof, wherein the antibody, or antibody fragment thereof,specifically binds to IL-6.

The invention also provides a method of treating emesis comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention further provides a method of preventing emesis comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides a composition for the treatment or prevention ofemesis comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5,Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention also provides a composition for the treatment of emesiscomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofemesis comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5,Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of emesis. In a further embodiment, saidcomposition may be formulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of emesis. In a further embodiment, said compositionmay be formulated for subcutaneous administration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of emesis. In a further embodiment, said compositionmay be formulated for subcutaneous administration.

The invention provides a method of treating or preventing emesisassociated with chemotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a method of treating emesis associated withchemotherapy comprising administration of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a method of preventing emesis associatedwith chemotherapy comprising administration of a composition comprisingan effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofemesis associated with chemotherapy comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a composition for the treatment of emesisassociated with chemotherapy comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofemesis associated with chemotherapy comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of emesis associated with chemotherapy.In a further embodiment, said composition may be formulated forsubcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of emesis associated with chemotherapy. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of emesis associated with chemotherapy. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides a method of treating or preventing emesisassociated with radiotherapy comprising administration of a compositioncomprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a method of treating emesis associated withradiotherapy comprising administration of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a method of preventing emesis associatedwith radiotherapy comprising administration of a composition comprisingan effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention provides a composition for the treatment or prevention ofemesis associated with radiotherapy comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a composition for the treatment of emesisassociated with radiotherapy comprising an effective amount of an Ab1,Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14,Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26,Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody,or an antibody fragment thereof, to a subject in need thereof, whereinthe antibody, or antibody fragment thereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofemesis associated with radiotherapy comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of emesis associated with radiotherapy.In a further embodiment, said composition may be formulated forsubcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of emesis associated with radiotherapy. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of emesis associated with radiotherapy. In a furtherembodiment, said composition may be formulated for subcutaneousadministration.

The invention provides a method of treating or preventing emesisassociated with hematopoietic stem cell transplant (HSCT). comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention also provides a method of treating emesis associated withhematopoietic stem cell transplant (HSCT). comprising administration ofa composition comprising an, effective amount of an Ab1, Ab2, Ab3, Ab4,Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17,Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29,Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibodyfragment thereof, to a subject in need thereof, wherein the antibody, orantibody fragment thereof, specifically binds to IL-6.

The invention further provides a method of preventing emesis associatedwith hematopoietic stem cell transplant (HSCT). comprisingadministration of a composition comprising an effective amount of anAb1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9, Ab10, Ab11, Ab12, Ab13,Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21, Ab22, Ab23, Ab24, Ab25,Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33, Ab34, Ab35, or Ab36antibody, or an antibody fragment thereof, to a subject in need thereof,wherein the antibody, or antibody fragment thereof, specifically bindsto IL-6.

The invention provides a composition for the treatment or prevention ofemesis associated with hematopoietic stem cell transplant (HSCT).comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention also provides a composition for the treatment of emesisassociated with hematopoietic stem cell transplant (HSCT). comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6.

The invention further provides a composition for the prevention ofemesis associated with hematopoietic stem cell transplant (HSCT).comprising an effective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7,Ab8, Ab9, Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19,Ab20, Ab21, Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31,Ab32, Ab33, Ab34, Ab35, or Ab36 antibody, or an antibody fragmentthereof, to a subject in need thereof, wherein the antibody, or antibodyfragment thereof, specifically binds to IL-6.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment or prevention of emesis associated with hematopoieticstem cell transplant (HSCT). In a further embodiment, said compositionmay be formulated for subcutaneous administration.

The invention also provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the treatment of emesis associated with hematopoietic stem celltransplant (HSCT). In a further embodiment, said composition may beformulated for subcutaneous administration.

The invention provides for the use of a composition comprising aneffective amount of an Ab1, Ab2, Ab3, Ab4, Ab5, Ab6, Ab7, Ab8, Ab9,Ab10, Ab11, Ab12, Ab13, Ab14, Ab15, Ab16, Ab17, Ab18, Ab19, Ab20, Ab21,Ab22, Ab23, Ab24, Ab25, Ab26, Ab27, Ab28, Ab29, Ab30, Ab31, Ab32, Ab33,Ab34, Ab35, or Ab36 antibody, or an antibody fragment thereof, to asubject in need thereof, wherein the antibody, or antibody fragmentthereof, specifically binds to IL-6, for the manufacture of a medicamentfor the prevention of emesis associated with hematopoietic stem celltransplant (HSCT). In a further embodiment, said composition may beformulated for subcutaneous administration.

In one embodiment, the antibody may comprise at least one light chainselected from the group consisting of an amino acid sequence with atleast about 90% sequence identity to an amino acid sequence of SEQ IDNO: 2, 20, 21, 37, 53, 69, 85, 101, 119, 122, 138, 154, 170, 186, 202,218, 234, 250, 266, 282, 298, 314, 330, 346, 362, 378, 394, 410, 426,442, 458, 474, 490, 506, 522, 538, 554, 570, 647, 648, 649, 650, 651,655, 660, 666, 667, 671, 675, 679, 683, 687, 693, 699, 702, 706, or 709.In a further embodiment, the antibody may comprise at least one lightchain selected from the group consisting of an amino acid sequence ofSEQ ID NO: 2, 20, 21, 37, 53, 69, 85, 101, 119, 122, 138, 154, 170, 186,202, 218, 234, 250, 266, 282, 298, 314, 330, 346, 362, 378, 394, 410,426, 442, 458, 474, 490, 506, 522, 538, 554, 570, 647, 648, 649, 650,651, 655, 660, 666, 667, 671, 675, 679, 683, 687, 693, 699, 702, 706, or709. In another embodiment, the antibody may comprise at least one lightchain selected from the group consisting of nucleic acid sequences withat least 90% sequence identity to a nucleic acid sequence of SEQ ID NO:10, 29, 45, 61, 77, 93, 109, 130, 146, 162, 178, 194, 210, 226, 242,258, 274, 290, 306, 322, 338, 354, 370, 386, 402, 418, 434, 450, 466,482, 498, 514, 530, 546, 562, 578, 662, 669, 673, 677, 681, 685, 689,698, 701, 705, 720, 721, 722, or 723, wherein said nucleic acid sequenceencodes said light chain. In further embodiment, the antibody maycomprise at least one light chain selected from the group consisting ofnucleic acid sequences of SEQ ID NO: 10, 29, 45, 61, 77, 93, 109, 130,146, 162, 178, 194, 210, 226, 242, 258, 274, 290, 306, 322, 338, 354,370, 386, 402, 418, 434, 450, 466, 482, 498, 514, 530, 546, 562, 578,662, 669, 673, 677, 681, 685, 689, 698, 701, 705, 720, 721, 722, or 723,wherein said nucleic acid sequence encodes said light chain.

In one embodiment, the antibody may comprise at least one heavy chainselected from the group consisting of an amino acid sequence with atleast about 90% sequence identity to an amino acid sequence of SEQ IDNO: 3, 18, 19, 22, 38, 54, 70, 86, 102, 117, 118, 123, 139, 155, 171,187, 203, 219, 235, 251, 267, 283, 299, 315, 331, 347, 363, 379, 395,411, 427, 443, 459, 475, 491, 507, 523, 539, 555, 571, 652, 653, 654,655, 656, 657, 658, 661, 664, 665, 668, 672, 676, 680, 684, 688, 691,692, 704, or 708. In further embodiment, the antibody may comprise atleast one heavy chain selected from the group consisting of an aminoacid sequence of SEQ ID NO: 3, 18, 19, 22, 38, 54, 70, 86, 102, 117,118, 123, 139, 155, 171, 187, 203, 219, 235, 251, 267, 283, 299, 315,331, 347, 363, 379, 395, 411, 427, 443, 459, 475, 491, 507, 523, 539,555, 571, 652, 653, 654, 655, 656, 657, 658, 661, 664, 665, 668, 672,676, 680, 684, 688, 691, 692, 704, or 708. In another embodiment, theantibody may comprise at least one heavy chain selected from the groupconsisting of nucleic acid sequences with at least 90% sequence identityto a nucleic acid sequence of SEQ ID NO: 11, 30, 46, 62, 78, 94, 110,131, 147, 163, 179, 195, 211, 227, 243, 259, 275, 291, 307, 323, 339,355, 371, 387, 403, 419, 435, 451, 467, 483, 499, 515, 531, 547, 563,579, 663, 670, 674, 678, 682, 686, 690, 700, 703, 707, 724, or 725,wherein said nucleic acid sequence encodes said heavy chain. In furtherembodiment, the antibody may comprise at least one heavy chain selectedfrom the group consisting of SEQ ID NO: 11, 30, 46, 62, 78, 94, 110,131, 147, 163, 179, 195, 211, 227, 243, 259, 275, 291, 307, 323, 339,355, 371, 387, 403, 419, 435, 451, 467, 483, 499, 515, 531, 547, 563,579, 663, 670, 674, 678, 682, 686, 690, 700, 703, 707, 724, or 725,wherein said nucleic acid sequence encodes said heavy chain.

In one embodiment, the antibody may comprise at least one CDR sequenceselected from the group consisting of an amino acid sequence with atleast about 90% sequence identity to an amino acid sequence of SEQ IDNO: 4, 7, 23, 26, 39, 42, 55, 58, 71, 74, 87, 90, 103, 106, 124, 127,140, 143, 156, 159, 172, 175, 188, 191, 204, 207, 220, 223, 236, 239,252, 255, 268, 271, 284, 287, 300, 303, 316, 319, 332, 335, 348, 351,364, 367, 380, 383, 396, 399, 412, 415, 428, 431, 444, 447, 460, 463,476, 479, 492, 495, 508, 511, 524, 527, 540, 543, 556, 559, 572, 575,710, 711, 712, 716, 5, 8, 24, 27, 40, 43, 56, 59, 72, 75, 88, 91, 104,107, 120, 121, 125, 128, 141, 144, 157, 160, 173, 176, 189, 192, 205,208, 221, 224, 237, 240, 253, 256, 269, 272, 285, 288, 301, 304, 317,320, 333, 336, 349, 352, 365, 368, 381, 384, 397, 400, 413, 416, 429,432, 445, 448, 461, 464, 477, 480, 493, 496, 509, 512, 525, 528, 541,544, 557, 560, 573, 576, 659, 713, 714, 715, 717, 718, 6, 9, 25, 28, 41,44, 57, 60, 73, 76, 89, 92, 105, 108, 126, 129, 142, 145, 158, 161, 174,177, 190, 193, 206, 209, 222, 225, 238, 241, 254, 257, 270, 273, 286,289, 302, 305, 318, 321, 334, 337, 350, 353, 366, 369, 382, 385, 398,401, 414, 417, 430, 433, 446, 449, 462, 465, 478, 481, 494, 497, 510,513, 526, 529, 542, 545, 558, 561, 574, or 577. In another embodiment,the antibody may comprise at least one CDR sequence selected from thegroup consisting of an amino acid sequence of SEQ ID NO: 4, 7, 23, 26,39, 42, 55, 58, 71, 74, 87, 90, 103, 106, 124, 127, 140, 143, 156, 159,172, 175, 188, 191, 204, 207, 220, 223, 236, 239, 252, 255, 268, 271,284, 287, 300, 303, 316, 319, 332, 335, 348, 351, 364, 367, 380, 383,396, 399, 412, 415, 428, 431, 444, 447, 460, 463, 476, 479, 492, 495,508, 511, 524, 527, 540, 543, 556, 559, 572, 575, 710, 711, 712, 716, 5,8, 24, 27, 40, 43, 56, 59, 72, 75, 88, 91, 104, 107, 120, 121, 125, 128,141, 144, 157, 160, 173, 176, 189, 192, 205, 208, 221, 224, 237, 240,253, 256, 269, 272, 285, 288, 301, 304, 317, 320, 333, 336, 349, 352,365, 368, 381, 384, 397, 400, 413, 416, 429, 432, 445, 448, 461, 464,477, 480, 493, 496, 509, 512, 525, 528, 541, 544, 557, 560, 573, 576,659, 713, 714, 715, 717, 718, 6, 9, 25, 28, 41, 44, 57, 60, 73, 76, 89,92, 105, 108, 126, 129, 142, 145, 158, 161, 174, 177, 190, 193, 206,209, 222, 225, 238, 241, 254, 257, 270, 273, 286, 289, 302, 305, 318,321, 334, 337, 350, 353, 366, 369, 382, 385, 398, 401, 414, 417, 430,433, 446, 449, 462, 465, 478, 481, 494, 497, 510, 513, 526, 529, 542,545, 558, 561, 574, or 577.

In one embodiment, the antibody may comprise at least one CDR selectedfrom the group consisting of nucleic acid sequences with at least about90% sequence identity to a nucleic acid sequence of SEQ ID NO: 12, 15,31, 34, 47, 50, 63, 66, 79, 82, 95, 98, 111, 114, 132, 135, 148, 151,164, 167, 180, 183, 196, 199, 212, 215, 228, 231, 244, 247, 260, 263,276, 279, 292, 295, 308, 311, 324, 327, 340, 343, 356, 359, 372, 375,388, 391, 404, 407, 420, 423, 436, 439, 452, 455, 468, 471, 484, 487,500, 503, 516, 519, 532, 535, 548, 551, 564, 567, 580, 583, 694, 13, 16,32, 35, 48, 51, 64, 67, 80, 83, 96, 99, 112, 115, 133, 136, 149, 152,165, 168, 181, 184, 197, 200, 213, 216, 229, 232, 245, 248, 261, 264,277, 280, 293, 296, 309, 312, 325, 328, 341, 344, 357, 360, 373, 376,389, 392, 405, 408, 421, 424, 437, 440, 453, 456, 469, 472, 485, 488,501, 504, 517, 520, 533, 536, 549, 552, 565, 568, 581, 584, 696, 14, 17,33, 36, 49, 52, 65, 68, 81, 84, 97, 100, 113, 116, 134, 137, 150, 153,166, 169, 182, 185, 198, 201, 214, 217, 230, 233, 246, 249, 262, 265,278, 281, 294, 297, 310, 313, 326, 329, 342, 345, 358, 361, 374, 377,390, 393, 406, 409, 422, 425, 438, 441, 454, 457, 470, 473, 486, 489,502, 505, 518, 521, 534, 537, 550, 553, 566, 569, 582, 585, 695, or 697,wherein said nucleic acid sequence encodes said CDR sequence. In afurther embodiment, the antibody may comprise at least one CDR selectedfrom the group consisting of nucleic acid sequences of SEQ ID NO: 12,15, 31, 34, 47, 50, 63, 66, 79, 82, 95, 98, 111, 114, 132, 135, 148,151, 164, 167, 180, 183, 196, 199, 212, 215, 228, 231, 244, 247, 260,263, 276, 279, 292, 295, 308, 311, 324, 327, 340, 343, 356, 359, 372,375, 388, 391, 404, 407, 420, 423, 436, 439, 452, 455, 468, 471, 484,487, 500, 503, 516, 519, 532, 535, 548, 551, 564, 567, 580, 583, 694,13, 16, 32, 35, 48, 51, 64, 67, 80, 83, 96, 99, 112, 115, 133, 136, 149,152, 165, 168, 181, 184, 197, 200, 213, 216, 229, 232, 245, 248, 261,264, 277, 280, 293, 296, 309, 312, 325, 328, 341, 344, 357, 360, 373,376, 389, 392, 405, 408, 421, 424, 437, 440, 453, 456, 469, 472, 485,488, 501, 504, 517, 520, 533, 536, 549, 552, 565, 568, 581, 584, 696,14, 17, 33, 36, 49, 52, 65, 68, 81, 84, 97, 100, 113, 116, 134, 137,150, 153, 166, 169, 182, 185, 198, 201, 214, 217, 230, 233, 246, 249,262, 265, 278, 281, 294, 297, 310, 313, 326, 329, 342, 345, 358, 361,374, 377, 390, 393, 406, 409, 422, 425, 438, 441, 454, 457, 470, 473,486, 489, 502, 505, 518, 521, 534, 537, 550, 553, 566, 569, 582, 585,695, or 697, wherein said nucleic acid sequence encodes said CDRsequence.

In another embodiment, the antibody or antibody fragment thereof maycomprise at least one light chain CDR polypeptide selected from thegroup consisting of an amino acid sequence with at least about 90%sequence identity to an amino acid sequence of SEQ ID NO: 4, 23, 39, 55,71, 74, 87, 103, 124, 140, 156, 172, 188, 204, 220, 236, 252, 268, 284,300, 316, 332, 348, 364, 380, 396, 412, 428, 444, 460, 476, 492, 508,524, 540, 556, 572, 710, 711, 712, 5, 24, 40, 56, 72, 88, 104, 125, 141,157, 173, 189, 205, 221, 237, 253, 269, 285, 301, 317, 333, 349, 365,381, 397, 413, 429, 445, 461, 477, 493, 509, 525, 541, 557, 573, 713,714, 715, 718, 25, 41, 57, 73, 89, 105, 126, 142, 158, 174, 190, 206,222, 238, 254, 270, 286, 302, 318, 334, 350, 366, 382, 398, 414, 430,446, 462, 478, 494, 510, 526, 542, 558, or 574. In another embodiment,the antibody or antibody fragment thereof may comprise at least onelight chain CDR1 polypeptide selected from the group consisting of anamino acid sequence with at least about 90% sequence identity to anamino acid sequence of SEQ ID NO: 4, 23, 39, 55, 71, 74, 87, 103, 124,140, 156, 172, 188, 204, 220, 236, 252, 268, 284, 300, 316, 332, 348,364, 380, 396, 412, 428, 444, 460, 476, 492, 508, 524, 540, 556, 572,710, 711, or 712. In another embodiment, the antibody or antibodyfragment thereof may comprise at least one light chain CDR2 polypeptideselected from the group consisting of an amino acid sequence with atleast about 90% sequence identity to an amino acid sequence of SEQ IDNO: 5, 24, 40, 56, 72, 88, 104, 125, 141, 157, 173, 189, 205, 221, 237,253, 269, 285, 301, 317, 333, 349, 365, 381, 397, 413, 429, 445, 461.7477, 493, 509, 525, 541, 557, 573, 713, 714, 715, or 718. In anotherembodiment, the antibody or antibody fragment thereof may comprise atleast one light chain CDR3 polypeptide selected from the groupconsisting of an amino acid sequence with at least about 90% sequenceidentity to an amino acid sequence of SEQ ID NO: 6, 25, 41, 57, 73, 89,105, 126, 142, 158, 174, 190, 206, 222, 238, 254, 270, 286, 302, 318,334, 350, 366, 382, 398, 414, 430, 446, 462, 478, 494, 510, 526, 542,558, or 574. In another embodiment, the antibody or antibody fragmentthereof may comprise at least two light chain CDR polypeptides. Inanother embodiment, the antibody or antibody fragment thereof maycomprise three light chain CDR polypeptides.

In another embodiment, the antibody or antibody fragment thereof maycomprise at least one heavy chain CDR polypeptide selected from thegroup consisting of an amino acid sequence with at least about 90%sequence identity to an amino acid sequence of SEQ ID NO: 7, 26, 42, 58,74, 90, 106, 127, 143, 159, 175, 191, 207, 223, 239, 255, 271, 287, 303,319, 335, 351, 367, 383, 399, 415, 431, 447, 463, 479, 495, 511, 527,543, 559, 575, 716, 8, 27, 43, 59, 75, 91, 107, 120, 121, 128, 144, 160,176, 192, 208, 224, 240, 256, 272, 288, 304, 320, 336, 352, 368, 384,400, 416, 432, 448, 464, 480, 496, 512, 528, 544, 560, 576, 659, 717,718, 9, 28, 44, 60, 76, 92, 108, 129, 145, 161, 177, 193, 209, 225, 241,257, 273, 289, 305, 321, 337, 353, 369, 385, 401, 417, 433, 449, 465,481, 497, 513, 529, 545, 561, or 577. In a further embodiment, theantibody or antibody fragment thereof may comprise at least one heavychain CDR1 polypeptide selected from the group consisting of an aminoacid sequence with at least about 90% sequence identity to an amino acidsequence of SEQ ID NO: 7, 26, 42, 58, 74, 90, 106, 127, 143, 159, 175,191, 207, 223, 239, 255, 271, 287, 303, 319, 335, 351, 367, 383, 399,415, 431, 447, 463, 479, 495, 511, 527, 543, 559, 575, or 716. In afurther embodiment, the antibody or antibody fragment thereof maycomprise at least one heavy chain CDR2 polypeptide selected from thegroup consisting of an amino acid sequence with at least about 90%sequence identity to an amino acid sequence of SEQ ID NO: 8, 27, 43, 59,75, 91, 107, 120, 121, 128, 144, 160, 176, 192, 208, 224, 240, 256, 272,288, 304, 320, 336, 352, 368, 384, 400, 416, 432, 448, 464, 480, 496,512, 528, 544, 560, 576, 659, 717, or 718. In a further embodiment, theantibody or antibody fragment thereof may comprise at least one heavychain CDR3 polypeptide selected from the group consisting of an aminoacid sequence with at least about 90% sequence identity to an amino acidsequence of SEQ ID NO: 9, 28, 44, 60, 76, 92, 108, 129, 145, 161, 177,193, 209, 225, 241, 257, 273, 289, 305, 321, 337, 353, 369, 385, 401,417, 433, 449, 465, 481, 497, 513, 529, 545, 561, or 577. In a furtherembodiment, the antibody or antibody fragment thereof may comprise atleast two heavy chain CDR polypeptides. In a further embodiment, theantibody or antibody fragment thereof may comprise three heavy chain CDRpolypeptides.

In one embodiment, the light chain of said antibody may be selected fromthe amino acid sequences of light chains listed in TABLE 4. In oneembodiment, the light chain of said antibody may be selected from theamino acid sequences of heavy chains listed in TABLE 4. In oneembodiment, at least one CDR of said antibody may be selected from theamino acid sequences of CDRs listed in TABLE 4. In another embodiment,the light chain may have at least 90% sequence identity to an amino acidsequence listed in TABLE 4. In another embodiment, the light chain mayhave at least 95% sequence identity to an amino acid sequence listed inTABLE 4. In another embodiment, the light chain may comprise an aminoacid sequence listed in TABLE 4. In further embodiment, the heavy chainmay have at least 90% sequence identity to an amino acid sequence listedin TABLE 4. In further embodiment, the heavy chain may have at least 95%sequence identity to an amino acid sequence listed in TABLE 4. Infurther embodiment, the heavy chain may comprise an amino acid sequencelisted in TABLE 4. In a still further embodiment, the CDR sequence ofthe antibody may have at least 90% sequence identity to an amino acidsequence listed in TABLE 4. In a still further embodiment, the CDRsequence of the antibody may have at least 95% sequence identity to anamino acid sequence listed in TABLE 4. In a still further embodiment,the CDR sequence of the antibody may comprise an amino acid sequencelisted in TABLE 4.

In one embodiment, the antibody or antibody fragment thereof, comprisesat least one of the CDRs contained in the V_(H) polypeptide sequencescomprising: SEQ ID NO: 3, 18, 19, 22, 38, 54, 70, 86, 102, 117, 118,123, 139, 155, 171, 187, 203, 219, 235, 251, 267, 283, 299, 315, 331,347, 363, 379, 395, 411, 427, 443, 459, 475, 491, 507, 523, 539, 555,571, 652, 656, 657, 658, 661, 664, 665, 668, 672, 676, 680, 684, 688,691, 692, 704, or 708 and/or at least one of the CDRs contained in theV_(L) polypeptide sequence consisting of: 2, 20, 21, 37, 53, 69, 85,101, 119, 122, 138, 154, 170, 186, 202, 218, 234, 250, 266, 282, 298,314, 330, 346, 362, 378, 394, 410, 426, 442, 458, 474, 490, 506, 522,538, 554, 570, 647, 651, 660, 666, 667, 671, 675, 679, 683, 687, 693,699, 702, 706, or 709.

In one embodiment, the antibody may be an Ab1 antibody. In oneembodiment, the antibody may comprise a light chain comprising the aminoacid sequence of SEQ ID NO: 2, 20, 647, 648, 649, 650, 651, 660, 666,699, 702, 706, or 709. In one embodiment, the antibody may comprise ahumanized light chain comprising the amino acid sequence of SEQ ID NO:648, 649, and 650. In one embodiment, the antibody may comprise at leastone light chain CDR comprising the amino acid sequence selected from thegroup consisting of SEQ ID NO: 4, 5, 6, 710, 711, 712, 713, 714, and715. In one embodiment, the antibody may comprise at least one humanizedlight chain CDR comprising the amino acid sequence selected from thegroup consisting of SEQ ID NO: 710, 711, 712, 713, 714, and 715. Inanother embodiment, the antibody may comprise a heavy chain comprisingthe amino acid sequence of SEQ ID NO: 3, 18, 19, 652, 653, 654, 655,656, 657, 658, 661, 664, 665, 704, 708. In another embodiment, theantibody may comprise a humanized heavy chain comprising the amino acidsequence of SEQ ID NO: 653, 654, and 655. In another embodiment, theantibody may comprise at least one heavy chain CDR comprising the aminoacid sequence selected from the group consisting of SEQ ID NO: 7, 9, 74,716, 8, 120, 659, 717, and 718. In another embodiment, the antibody maycomprise at least one humanized heavy chain CDR comprising the aminoacid sequence selected from the group consisting of SEQ ID NO: 74, 716,717, and 718. In a further embodiment, the Ab1 antibody may comprise alight chain comprising the amino acid sequence of SEQ ID NO: 709 and aheavy chain comprising the amino acid sequence of SEQ ID NO: 657. In afurther embodiment, the Ab1 antibody may comprise a light chaincomprising the amino acid sequence of SEQ ID NO: 20 and a heavy chaincomprising the amino acid sequence of SEQ ID NO: 19.

In one embodiment, the antibody or antibody fragment thereof may beadministered to the subject in the form of at least one nucleic acidsthat encode the antibody. In one embodiment, the light chain of saidantibody or antibody fragment thereof may be encoded by at least one ofthe following nucleic acid sequences of SEQ ID NOs: 10, 29, 45, 61, 77,93, 109, 130, 146, 162, 178, 194, 210, 226, 242, 258, 274, 290, 306,322, 338, 354, 370, 386, 402, 418, 434, 450, 466, 482, 498, 514, 530,546, 562, 578, 662, 669, 673, 677, 681, 685, 689, 698, 701, 705, 720,721, 722, or 723. In another embodiment, the heavy chain of saidantibody or antibody fragment thereof may be encoded by at least one ofthe following nucleic acid sequences of SEQ ID NOs: 11, 30, 46, 62, 78,94, 110, 131, 147, 163, 179, 195, 211, 227, 243, 259, 275, 291, 307,323, 339, 355, 371, 387, 403, 419, 435, 451, 467, 483, 499, 515, 531,547, 563, 579, 663, 670, 674, 678, 682, 686, 690, 700, 703, 707, 724, or725. In another embodiment, at least one of the CDRs of said antibody orantibody fragment thereof may be encoded by at least one of thefollowing nucleic acid sequences of SEQ ID NOs: 12, 15, 31, 34, 47, 50,63, 66, 79, 82, 95, 98, 111, 114, 132, 135, 148, 151, 164, 167, 180,183, 196, 199, 212, 215, 228, 231, 244, 247, 260, 263, 276, 279, 292,295, 308, 311, 324, 327, 340, 343, 356, 359, 372, 375, 388, 391, 404,407, 420, 423, 436, 439, 452, 455, 468, 471, 484, 487, 500, 503, 516,519, 532, 535, 548, 551, 564, 567, 580, 583, 694, 13, 16, 32, 35, 48,51, 64, 67, 80, 83, 96, 99, 112, 115, 133, 136, 149, 152, 165, 168, 181,184, 197, 200, 213, 216, 229, 232, 245, 248, 261, 264, 277, 280, 293,296, 309, 312, 325, 328, 341, 344, 357, 360, 373, 376, 389, 392, 405,408, 421, 424, 437, 440, 453, 456, 469, 472, 485, 488, 501, 504, 517,520, 533, 536, 549, 552, 565, 568, 581, 584, 696, 14, 17, 33, 36, 49,52, 65, 68, 81, 84, 97, 100, 113, 116, 134, 137, 150, 153, 166, 169,182, 185, 198, 201, 214, 217, 230, 233, 246, 249, 262, 265, 278, 281,294, 297, 310, 313, 326, 329, 342, 345, 358, 361, 374, 377, 390, 393,406, 409, 422, 425, 438, 441, 454, 457, 470, 473, 486, 489, 502, 505,518, 521, 534, 537, 550, 553, 566, 569, 582, 585, 695, or 697. Inanother embodiment, at least one nucleic acids may comprise the heavyand light chain polynucleotide sequences of SEQ ID NO: 723 and SEQ IDNO: 700; SEQ ID NO: 701 and SEQ ID NO: 703; SEQ ID NO: 705 and SEQ IDNO: 707; SEQ ID NO: 720 and SEQ ID NO: 724; and SEQ ID NO: 10 and SEQ IDNO: 11.

In one embodiment, the antibody or antibody fragment thereof may beasialated. In one embodiment, the antibody or antibody fragment thereofmay be humanized. In one embodiment, the antibody or antibody fragmentthereof may have a half-life of at least about 30 days. In oneembodiment, the antibody or antibody fragment thereof may comprise thehumanized variable light sequence of amino acid sequence of SEQ ID NO:709. In one embodiment, the antibody or antibody fragment thereof maycomprise humanized variable heavy sequence of amino acid sequence of SEQID NO: 657. In another embodiment, the antibody or antibody fragmentthereof may comprise at least one light chain CDRs as set forth in theamino acid sequence of SEQ ID NOs: 4, 5, or 6. In another embodiment,the antibody or antibody fragment thereof may comprise at least oneheavy chain CDRs as set forth in the amino acid sequence of SEQ ID NOs:7, 120, or 9. In further embodiment, the antibody or antibody fragmentthereof may be an asialated, humanized anti-IL-6 monoclonal antibodywith a half-life of −30 days comprising the humanized variable light andheavy sequences as set forth in SEQ ID NO: 20 and 19. In furtherembodiment, the antibody or antibody fragment thereof may be anasialated, humanized anti-IL-6 monoclonal antibody with a half-life of−30 days comprising the humanized variable light and heavy sequences asset forth in SEQ ID NO: 709 and 657.

In a preferred embodiment this is effected by the administration of theantibodies described herein, comprising the sequences of the V_(H),V_(L) and CDR polypeptides described in Table 4, or humanized orchimeric or single chain versions thereof containing at least one of theCDRs of the exemplified anti-IL-6 antibody sequences and thepolynucleotides encoding them. Preferably these antibodies will beaglycosylated. In more specific embodiments of the invention theseantibodies will block gp130 activation and/or possess binding affinities(Kds) less than 50 picomolar and/or K_(off) values less than or equal to10⁻⁴ S⁻¹.

The invention also contemplates methods of making said humanizedanti-IL-6 or anti-IL-6/IL-6R complex antibodies and binding fragmentsand variants thereof. In one embodiment, binding fragments include, butare not limited to, Fab, Fab′, F(ab′)₂, Fv and scFv fragments.

In one embodiment, the anti-IL-6 antibodies block the effects of IL-6.In another embodiment, the anti-IL-6 antibody is a humanized monoclonalantibody that binds to free human IL-6 and soluble IL-6R/IL-6 complexwith an affinity of at least about 4 pM. In another embodiment, theanti-IL-6 antibody, has a serum half-life about at least 30 days. Inanother embodiment, the anti-IL-6 antibody is based on a consensus humanIgG1 kappa framework that had asparagines modified to alanine toeliminate N-glycosylation sites.

In another embodiment, the antibodies and humanized versions may bederived from rabbit immune cells (B lymphocytes) and may be selectedbased on their homology (sequence identity) to human germ linesequences. These antibodies may require minimal or no sequencemodifications, thereby facilitating retention of functional propertiesafter humanization. In exemplary embodiments, the humanized antibodiesmay comprise human frameworks which are highly homologous (possess highlevel of sequence identity) to that of a parent (e.g. rabbit) antibody.

In an embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may specifically bind to the same linear orconformational epitopes on an intact IL-6 polypeptide or fragmentthereof which may include at least fragments selected from thoseencompassing amino acid residues 37-51, amino acid residues 70-84, aminoacid residues 169-183, amino acid residues 31-45 and/or amino acidresidues 58-72.

In a preferred exemplary embodiment, the anti-IL-6 antibody willcomprise at least one of the CDRs in listed in Table 4. In a morepreferred embodiment the anti-IL-6 antibody will comprise the variableheavy and light chain sequences in SEQ ID NO: 657 and SEQ ID NO: 709, orvariants thereof.

In a preferred embodiment the humanized anti-IL-6 antibody will comprisethe variable heavy and variable light chain sequences respectively setforth in SEQ ID NO: 657 and SEQ ID NO: 709, and preferably furthercomprising the heavy chain and light chain constant regions respectivelyset forth in SEQ ID NO: 588 and SEQ ID NO: 586, and variants thereofcomprising at least one amino acid substitutions or deletions that donot substantially affect IL-6 binding and/or desired effector function.This embodiment also contemplates polynucleotides comprising, oralternatively consisting of, at least one of the nucleic acids encodingthe variable heavy chain (SEQ ID NO: 700) and variable light chain (SEQID NO: 723) sequences and the constant region heavy chain (SEQ ID NO:589) and constant region light chain (SEQ ID NO: 587) sequences. Thisembodiment further contemplates nucleic acids encoding variantscomprising at least one amino acid substitutions or deletions to thevariable heavy and variable light chain sequences respectively set forthin SEQ ID NO: 657 and SEQ ID NO: 709 and the heavy chain and light chainconstant regions respectively set forth in SEQ ID NO: 588 and SEQ ID NO:586, that do not substantially affect IL-6 binding and/or desiredeffector function.

In an embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may be aglycosylated or substantiallyaglycosylated, e.g., as a result of one or more modifications in the Fcregion of the antibody.

In an embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may contain an Fc region that has beenmodified to alter effector function, half-life, proteolysis, and/orglycosylation. Preferably the Fc region is modified to eliminateglycosylation.

In an embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may be a human, humanized, single chain orchimeric antibody.

In an embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may be a humanized antibody derived from arabbit (parent) anti-IL-6 antibody.

In an embodiment of the invention, the framework regions (FRs) in thevariable light region and the variable heavy regions of said anti-IL-6antibody or antibody fragment or variant thereof respectively may behuman FRs which are unmodified or which have been modified by thesubstitution of at most 2 or 3 human FR residues in the variable lightor heavy chain region with the corresponding FR residues of the parentrabbit antibody, and the human FRs may have been derived from humanvariable heavy and light chain antibody sequences which have beenselected from a library of human germline antibody sequences based ontheir high level of homology to the corresponding rabbit variable heavyor light chain regions relative to other human germline antibodysequences contained in the library. As disclosed in detail infra in apreferred embodiment the antibody will comprise human FRs which areselected based on their high level of homology (degree of sequenceidentity) to that of the parent antibody that is humanized.

In one embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may comprise a heavy chain polypeptidesequence comprising: SEQ ID NO: 3, 18, 19, 652, 656, 657, 658, 661, 664,665, 704, or 708; and may further comprise a VL polypeptide sequencecomprising: SEQ ID NO: 2, 20, 647, 651, 660, 666, 699, 702, 706, or 709or a variant thereof wherein at least one of the framework residues (FRresidues) in said VH or VL polypeptide may have been substituted withanother amino acid residue resulting in an anti-IL-6 antibody orantibody fragment or variant thereof that specifically binds human IL-6,or may comprise a polypeptide wherein the CDRs therein are incorporatedinto a human framework homologous to said sequence. Preferably thevariable heavy and light sequences comprise those in SEQ ID NO: 657 and709.

In an embodiment of the invention, at least one of said FR residues maybe substituted with an amino acid present at the corresponding site in aparent rabbit anti-IL-6 antibody from which the complementaritydetermining regions (CDRs) contained in said VH or VL polypeptides havebeen derived or by a conservative amino acid substitution.

In an embodiment of the invention, said anti-IL-6 antibody, or antibodyfragment or variant thereof, may be humanized. In an embodiment of theinvention, said anti-IL-6 antibody, or antibody fragment or variantthereof, may be chimeric.

In an embodiment of the invention, said anti-IL-6 antibody, or antibodyfragment or variant thereof, further may comprise a human Fc, e.g., anFc region comprised of the variable heavy and light chain constantregions set forth in SEQ ID NO: 704 and 702.

In an embodiment of the invention, said human Fc may be derived fromIgG1, IgG2, IgG3, IgG4, IgG5, IgG6, IgG7, IgG8, IgG9, IgG10, IgG11,IgG12, IgG13, IgG14, IgG15, IgG16, IgG17, IgG18 or IgG19.

In an embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may comprise a polypeptide having at leastabout 90% sequence homology to at least one of the polypeptide sequencesof SEQ ID NO: 3, 18, 19, 652, 656, 657, 658, 661, 664, 665, 704, 708, 2,20, 647, 651, 660, 666, 699, 702, 706, and 709.

In an embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may have an elimination half-life of atleast about 30 days.

In one embodiment, the antibody, or antibody fragment thereof, mayinhibit with at least one activity associated with IL-6. In anotherembodiment, the at least one activity associated with IL-6 may be an invitro activity comprising stimulation of proliferation of T1165 cells;binding of IL-6 to IL-6R; activation (dimerization) of the gp130signal-transducing glycoprotein; formation of IL-6/IL-6R/gp130multimers; stimulation of haptoglobin production by HepG2 cells modifiedto express human IL-6 receptor; or any combination thereof. In oneembodiment, prior to administration of the antibody, or antibodyfragment thereof, the subject may have exhibited or may be at risk fordeveloping at least one of the following symptoms: elevated serumC-reactive protein (“CRP”); elevated erythrocyte sedimentation rate; ora combination thereof.

In one embodiment, the antibody or antibody fragment thereof maycomprise a Fab, Fab′, F(ab′)₂, Fv, scFv, IgNAR, SMIP, camelbody, ornanobody. In one embodiment, the antibody or antibody fragment thereofmay have an in vivo half-life of at least about 30 days in a healthyhuman subject. In one embodiment, the antibody or antibody fragmentthereof may have a binding affinity (Kd) for IL-6 of less than about 50picomolar, or a rate of dissociation (K_(off)) from IL-6 of less than orequal to 10⁻⁴ S⁻¹. In one embodiment, the antibody or antibody fragmentthereof may specifically binds to the same linear or conformationalepitope(s) and/or competes for binding to the same linear orconformational epitope(s) on an intact human IL-6 polypeptide orfragment thereof as an anti-IL-6 antibody comprising the polypeptides ofSEQ ID NO: 702 and SEQ ID NO: 704 or the polypeptides of SEQ ID NO: 2and SEQ ID NO: 3. In one embodiment, the binding to the same linear orconformational epitope(s) and/or competition for binding to the samelinear or conformational epitope(s) on an intact human IL-6 polypeptideor fragment thereof is ascertained by epitopic mapping using overlappinglinear peptide fragments which span the full length of the native humanIL-6 polypeptide and includes at least one residues comprised in IL-6fragments selected from those respectively encompassing amino acidresidues 37-51, amino acid residues 70-84, amino acid residues 169-183,amino acid residues 31-45 and/or amino acid residues 58-72 of SEQ ID NO:1.

In one embodiment, the antibody or antibody fragment thereof, may beaglycosylated. In one embodiment, the antibody, or antibody fragmentthereof, may contain an Fc region that has been modified to altereffector function, half-life, proteolysis, and/or glycosylation. In oneembodiment, the antibody, or antibody fragment thereof, may be a human,humanized, single chain, or chimeric antibody. In one embodiment, theantibody, or antibody fragment thereof, may comprise a Fab, Fab′,F(ab′)₂, Fv, or scFv. In one embodiment, the antibody, or antibodyfragment thereof, may further comprise a human F_(o). In anotherembodiment, the F_(c) may be derived from IgG1, IgG2, IgG3, IgG4, IgG5,IgG6, IgG7, IgG8, IgG9, IgG10, IgG11, IgG12, IgG13, IgG14, IgG15, IgG16,IgG17, IgG18, or IgG19.

In one embodiment, the composition may comprise at least about 25, 80,100, 160, 200, or 320 mg. In one embodiment, the effective amount may bebetween about 0.1 and 100 mg/kg of body weight of the subject. In oneembodiment, the subject may be administered at least 1, 2, 3, 4, or 5doses. In one embodiment, composition may be administered every 4 weeks.In one embodiment, the subject may be administered 25 mg every 4 weeks.In one embodiment, the subject may be administered 80 mg every 4 weeks.In one embodiment, the subject may be administered 100 mg every 4 weeks.In one embodiment, the subject may be administered 160 mg every 4 weeks.In one embodiment, the subject may be administered 200 mg every 4 weeks.In one embodiment, the subject may be administered 320 mg every 4 weeks.In another embodiment, the composition may be administered every 4 weeksfor at least 16 weeks. In another embodiment, the composition may beadministered every 4 weeks for at least 24 weeks.

In this embodiment, anti-IL-6 antibodies, or antibody fragments thereofmay be administered at effective doses to less inflammation, pain, andloss of mobility experienced from mucositis, e.g., dosages ranging fromabout 25-500 mg, more preferably at least about 25, 80, 100, 120, 160,200, 240, or 320 mg dosages.

In one embodiment, the antibody may comprise a light chain polypeptidethat comprises at least one Ab1 light chain CDR polypeptide comprising alight chain CDR1 having at least 72.7% sequence identity to SEQ ID NO:4; a light chain CDR2 having at least 85.7% sequence identity to SEQ IDNO: 5; a light chain CDR3 having at least about 90% sequence identity toSEQ ID NO: 6; a light chain CDR1 having at least 90.9% sequence identityto SEQ ID NO: 4; a light chain CDR2 having at least 100% sequenceidentity to SEQ ID NO: 5; or a light chain CDR3 having at least 66.6%sequence identity to SEQ ID NO: 6; and wherein the heavy chainpolypeptide comprises at least one Ab1 heavy chain CDR polypeptidecomprising a heavy chain CDR1 having at least 80% sequence identity toSEQ ID NO: 7; a heavy chain CDR2 having at least about 90% sequenceidentity to SEQ ID NO: 120; a heavy chain CDR3 having at least 33.3%sequence identity to SEQ ID NO: 9; a heavy chain CDR1 having at least100% sequence identity to SEQ ID NO: 7; a heavy chain CDR2 having atleast 56.2% sequence identity to SEQ ID NO: 120; or a heavy chain CDR3having at least 50% sequence identity to SEQ ID NO: 9.

In a further embodiment, the antibody or antibody fragment may comprisea light chain polypeptide comprises at least one Ab1 light chain CDRpolypeptide comprising a tight chain CDR1 having at least 81.8% sequenceidentity to SEQ ID NO: 4; a light chain CDR2 having at least 71.4%sequence identity to SEQ ID NO: 5; or a light chain CDR3 having at least83.3% sequence identity to SEQ ID NO: 6; and wherein the heavy chainpolypeptide comprises at least one Ab1 heavy chain CDR polypeptidecomprising a heavy chain CDR1 having at least 60% sequence identity toSEQ ID NO: 7; a heavy chain CDR2 having at least 87.5% sequence identityto SEQ ID NO: 120; or a heavy chain CDR3 having at least 83.3% sequenceidentity to SEQ ID NO: 9. In a further embodiment, the antibody orantibody fragment may comprise antibody or antibody fragment comprisesat least two of said light chain CDR polypeptides and at least two ofsaid heavy chain CDR polypeptides.

In a further embodiment, the antibody or antibody fragment may comprisetwo or more Ab1 light chain CDR polypeptides comprising a light chainCDR1 having at least 72.7% sequence identity to SEQ ID NO: 4; a lightchain CDR2 having at least 85.7% sequence identity to SEQ ID NO: 5; or alight chain CDR3 having at least about 90% sequence identity to SEQ IDNO: 6; and two or more Ab1 heavy chain CDR polypeptide comprising aheavy chain CDR1 having at least 80% sequence identity (identical to atleast 4 out of 5 residues) to SEQ ID NO: 7; a heavy chain CDR2 having atleast about 90% sequence identity to SEQ ID NO: 120; or a heavy chainCDR3 having at least 33.3% sequence identity to SEQ ID NO: 9; whereinthe Ab1 antibody or antibody fragment specifically binds to IL-6 andantagonizes at least one activity associated with IL-6.

In a further embodiment, the antibody or antibody fragment may comprisetwo or more Ab1 light chain CDR polypeptides comprising a light chainCDR1 having at least 90.9% sequence identity to SEQ ID NO: 4; a lightchain CDR2 having at least 100% sequence identity to SEQ ID NO: 5; or alight chain CDR3 having at least 66.6% sequence identity to SEQ ID NO:6; and two or more Ab1 heavy chain CDR polypeptide comprising a heavychain CDR1 having at least 100% sequence identity to SEQ ID NO: 7; aheavy chain CDR2 having at least 56.2% sequence identity to SEQ ID NO:120; or a heavy chain CDR3 having at least 50% sequence identity to SEQID NO: 9; wherein the Ab1 antibody or antibody fragment specificallybinds to IL-6 and antagonizes at least one activity associated withIL-6.

In a further embodiment, the Ab1 antibody or antibody fragment comprisessaid light chain CDR1, said light chain CDR3, said heavy chain CDR2, andsaid heavy chain CDR3.

In one embodiment, the antibody or antibody fragment may compriseantibody or antibody fragment thereof is administered to the subject inthe form of at least one nucleic acids that encode the antibody orantibody fragment thereof.

In one embodiment, the antibody or antibody fragment may comprise alight chain of encoded by at least one of the following nucleic acidsequences of SEQ ID NOs: 10, 29, 45, 61, 77, 93, 109, 130, 146, 162,178, 194, 210, 226, 242, 258, 274, 290, 306, 322, 338, 354, 370, 386,402, 418, 434, 450, 466, 482, 498, 514, 530, 546, 562, 578, 662, 669,673, 677, 681, 685, 689, 698, 701, 705, 720, 721, 722, or 723.

In one embodiment, the antibody or antibody fragment may comprise aheavy chain of said antibody or antibody fragment thereof is encoded byat least one of the following nucleic acid sequences of SEQ ID NOs: 11,30, 46, 62, 78, 94, 110, 131, 147, 163, 179, 195, 211, 227, 243, 259,275, 291, 307, 323, 339, 355, 371, 387, 403, 419, 435, 451, 467, 483,499, 515, 531, 547, 563, 579, 663, 670, 674, 678, 682, 686, 690, 700,703, 707, 724, or 725.

In one embodiment, the antibody or antibody fragment may comprise atleast one of the CDRs of said antibody or antibody fragment thereof isencoded by at least one of the following nucleic acid sequences of SEQID NOs: 12, 15, 31, 34, 47, 50, 63, 66, 79, 82, 95, 98, 111, 114, 132,135, 148, 151, 164, 167, 180, 183, 196, 199, 212, 215, 228, 231, 244,247, 260, 263, 276, 279, 292, 295, 308, 311, 324, 327, 340, 343, 356,359, 372, 375, 388, 391, 404, 407, 420, 423, 436, 439, 452, 455, 468,471, 484, 487, 500, 503, 516, 519, 532, 535, 548, 551, 564, 567, 580,583, 694, 13, 16, 32, 35, 48, 51, 64, 67, 80, 83, 96, 99, 112, 115, 133,136, 149, 152, 165, 168, 181, 184, 197, 200, 213, 216, 229, 232, 245,248, 261, 264, 277, 280, 293, 296, 309, 312, 325, 328, 341, 344, 357,360, 373, 376, 389, 392, 405, 408, 421, 424, 437, 440, 453, 456, 469,472, 485, 488, 501, 504, 517, 520, 533, 536, 549, 552, 565, 568, 581,584, 696, 14, 17, 33, 36, 49, 52, 65, 68, 81, 84, 97, 100, 113, 116,134, 137, 150, 153, 166, 169, 182, 185, 198, 201, 214, 217, 230, 233,246, 249, 262, 265, 278, 281, 294, 297, 310, 313, 326, 329, 342, 345,358, 361, 374, 377, 390, 393, 406, 409, 422, 425, 438, 441, 454, 457,470, 473, 486, 489, 502, 505, 518, 521, 534, 537, 550, 553, 566, 569,582, 585, 695, or 697.

In one embodiment, the antibody or antibody fragment may comprise atleast one of the nucleic acids comprise the heavy and light chainpolynucleotide sequences of SEQ ID NO: 723 and SEQ ID NO: 700; SEQ IDNO: 701 and SEQ ID NO: 703; SEQ ID NO: 705 and SEQ ID NO: 707; SEQ IDNO: 720 and SEQ ID NO: 724; and SEQ ID NO: 10 and SEQ ID NO: 11.

In one embodiment, the antibody or antibody fragment may comprise ahumanized variable light sequence of amino acid sequence of SEQ ID NO:709.

In one embodiment, the antibody or antibody fragment may comprise ahumanized variable heavy sequence of amino acid sequence of SEQ ID NO:657.

In one embodiment, the antibody or antibody fragment may comprise atleast one light chain CDRs as set forth in the amino acid sequence ofSEQ ID NOs: 4, 5, or 6.

In one embodiment, the antibody or antibody fragment may comprise atleast one heavy chain CDRs as set forth in the amino acid sequence ofSEQ ID NOs: 7, 120, or 9.

In one embodiment, the antibody or antibody fragment may be anasialated, humanized anti-IL-6 monoclonal antibody with a half-life of˜30 days comprising the humanized variable light and heavy sequences asset forth in SEQ ID NO: 20 and 19 or SEQ ID NO: 709 or 657.

In one embodiment, the antibody or antibody fragment may be expressedfrom a recombinant cell. In another embodiment, the cell may be amammalian, yeast, bacterial, and insect cell. In another embodiment, thecell may be a yeast cell. In another embodiment, the cell may be adiploidal yeast cell. In another embodiment, the yeast cell may be aPichia yeast. In one embodiment, the antibody may be asialated. In oneembodiment, the antibody may be humanized.

In one embodiment, the antibody or antibody fragment thereof maycomprise a Fab, Fab′, F(ab′)₂, Fv, scFv, IgNAR, SMIP, camelbody, ornanobody.

In one embodiment, the antibody or antibody fragment thereof may have anin vivo half-life of at least about 30 days.

In one embodiment, the antibody or antibody fragment thereof may have abinding affinity (Kd) for IL-6 of less than about 50 picomolar, or arate of dissociation (K_(off)) from IL-6 of less than or equal to 10⁻⁴S⁻¹.

In one embodiment, the antibody or antibody fragment thereof mayspecifically binds to the same linear or conformational epitope(s)and/or competes for binding to the same linear or conformationalepitope(s) on an intact human IL-6 polypeptide or fragment thereof as ananti-IL-6 antibody comprising the polypeptides of SEQ ID NO: 702 and SEQID NO: 704 or the polypeptides of SEQ ID NO: 2 and SEQ ID NO: 3.

In one embodiment, the antibody or antibody fragment thereof may havebinding to the same linear or conformational epitope(s) and/orcompetition for binding to the same linear or conformational epitope(s)on an intact human IL-6 polypeptide or fragment thereof is ascertainedby epitopic mapping using overlapping linear peptide fragments whichspan the full length of the native human IL-6 polypeptide and includesat least one residues comprised in IL-6 fragments selected from thoserespectively encompassing amino acid residues 37-51, amino acid residues70-84, amino acid residues 169-183, amino acid residues 31-45 and/oramino acid residues 58-72 of SEQ ID NO: 1.

In one embodiment, the antibody or antibody fragment thereof may beaglycosylated. In one embodiment, the antibody or antibody fragmentthereof may comprise an Fc region that has been modified to altereffector function, half-life, proteolysis, and/or glycosylation. In oneembodiment, the antibody or antibody fragment thereof may be a human,humanized, single chain, or chimeric antibody. In one embodiment, theantibody or antibody fragment thereof may further comprise a humanF_(c). The method or use of claim 126, wherein said human Fc is derivedfrom IgG1, IgG2, IgG3, IgG4, IgG5, IgG6, IgG7, IgG8, IgG9, IgG10, IgG11,IgG12, IgG13, IgG14, IgG15, IgG16, IgG17, IgG18, or IgG19.

In one embodiment, the chemotherapy may comprise administration of achemotherapy agent selected from the group consisting of Alemtuzumab(Campath®), Asparaginase (Elspar®), Bleomycin (Blenoxane®), Busulfan(Myleran®, Busulfex®), Capecitabine (Xeloda®), Carboplatin(Paraplatin®), Cisplatin (PLATINOL®), Cyclophosphamide (Cytoxan®),Cytarabine (Cytosar-U®), Daunorubicin (Cerubidine®), Docetaxel(Taxotere®), Doxorubicin (Adriamycin®), Epirubicin (Ellence®), Etoposide(VePesid®), Fluorouracil (5-FU®), Gemcitabine (Gemzar®), Gemtuzumabozogamicin (Mylotarg®), Hydroxyurea (Hydrea®), Idarubicin (Idamycin®),Interleukin 2 (Proleukin®), Irinotecan (Camptosar®), Lomustine (CeeNU®),Mechlorethamine (Mustargen®), Melphalan (Alkeran®), Methotrexate(Rheumatrex®), Mitomycin (Mutamycin®), Mitoxantrone (Novantrone®),Oxaliplatin (Eloxatin®), Paclitaxel (Taxol®), Pemetrexed (Alimta®),Pentostatin (Nipent®), Procarbazine (Matulane®), Thiotepa (Thioplex®),Topotecan (Hycamtin®), Trastuzumab (Herceptin®), Tretinoin (Vesanoid®),Vinblastine (Velban®), or Vincristine (Oncovin®).

In one embodiment, the patient may have elevated C-reactive protein(“CRP”). In one embodiment, the patient may have elevated IL-6 serumlevel. In one embodiment, the patient may have elevated IL-6 level inthe joints.

In one embodiment, the IL-antagonist may inhibit at least one activityassociated with IL-6. In another embodiment, the at least one activityassociated with IL-6 is an in vitro activity comprising stimulation ofproliferation of T1165 cells; binding of IL-6 to IL-6R; activation(dimerization) of the gp130 signal-transducing glycoprotein; formationof IL-6/IL-6R/gp130 multimers; stimulation of haptoglobin production byHepG2 cells modified to express human IL-6 receptor; or any combinationthereof.

In another embodiment, prior to administration of the IL-6 antagonist,optionally an antibody or antibody fragment, the subject has exhibitedor is at risk for developing at least one of the following symptoms:decreased serum albumin; elevated serum C-reactive protein (“CRP”);elevated erythrocyte sedimentation rate; fatigue; fever; anorexia (lossof appetite); weight loss; cachexia; weakness; decreased GlasgowPrognostic Score (“GPS”); elevated serum D-dimer; abnormal coagulationprofile; and any combination thereof.

In another embodiment, the symptom may be a side-effect of anothertherapeutic agent administered to the subject prior to, concurrent with,or subsequent to administration of the antibody or antibody fragment. Inanother embodiment, the method may further comprise monitoring thesubject to assess said symptom subsequent to administration of theantibody. In another embodiment, the symptom may be exhibited prior toadministration of said IL-6 antagonist, optionally an anti-IL-6 antibodyor antibody fragment. In another embodiment, the symptom may be improvedor restored to a normal condition within about 1-5 weeks ofadministration of said IL-6 antagonist, optionally an anti-IL-6 antibodyor antibody fragment. In another embodiment, the symptom may thereafterremains improved for an entire period intervening two consecutiveadministrations of said IL-6 antagonist, optionally an anti-IL-6antibody or antibody fragment. In another embodiment, the patienttreated may have at least one symptom of oral, alimentary, orgastrointestinal tract mucositis.

In another embodiment, the patient treated may have cancer or is beingtreated for cancer. In one embodiment, the cancer is selected from thegroup consisting of Acanthoma, Acinic cell carcinoma, Acoustic neuroma,Acral lentiginous melanoma, Acrospiroma, Acute eosinophilic leukemia,Acute lymphoblastic leukemia, Acute megakaryoblastic leukemia, Acutemonocytic leukemia, Acute myeloblastic leukemia with maturation, Acutemyeloid dendritic cell leukemia, Acute myeloid leukemia, Acutepromyelocytic leukemia, Adamantinoma, Adenocarcinoma, Adenoid cysticcarcinoma, Adenoma, Adenomatoid odontogenic tumor, Adrenocorticalcarcinoma, Adult T-cell leukemia, Aggressive NK-cell leukemia,AIDS-Related Cancers, AIDS-related lymphoma, Alveolar soft part sarcoma,Ameloblastic fibroma, Anal cancer, Anaplastic large cell lymphoma,Anaplastic thyroid cancer, Angioimmunoblastic T-cell lymphoma,Angiomyolipoma, Angiosarcoma, Appendix cancer, Astrocytoma, Atypicalteratoid rhabdoid tumor, Basal cell carcinoma, Basal-like carcinoma,B-cell leukemia, B-cell lymphoma, Bellini duct carcinoma, Biliary tractcancer, Bladder cancer, Blastoma, Bone Cancer, Bone tumor, Brain StemGlioma, Brain Tumor, Breast Cancer, Brenner tumor, Bronchial Tumor,Bronchioloalveolar carcinoma, Brown tumor, Burkitt's lymphoma, Cancer ofUnknown Primary Site, Carcinoid Tumor, Carcinoma, Carcinoma in situ,Carcinoma of the penis, Carcinoma of Unknown Primary Site,Carcinosarcoma, Castleman's Disease, Central Nervous System EmbryonalTumor, Cerebellar Astrocytoma, Cerebral Astrocytoma, Cervical Cancer,Cholangiocarcinoma, Chondroma, Chondrosarcoma, Chordoma,Choriocarcinoma, Choroid plexus papilloma, Chronic Lymphocytic Leukemia,Chronic monocytic leukemia, Chronic myelogenous leukemia, ChronicMyeloproliferative Disorder, Chronic neutrophilic leukemia, Clear-celltumor, Colon Cancer, Colorectal cancer, Craniopharyngioma, CutaneousT-cell lymphoma, Degos disease, Dermatofibrosarcoma protuberans, Dermoidcyst, Desmoplastic small round cell tumor, Diffuse large B celllymphoma, Dysembryoplastic neuroepithelial tumor, Embryonal carcinoma,Endodermal sinus tumor, Endometrial cancer, Endometrial Uterine Cancer,Endometrioid tumor, Enteropathy-associated T-cell lymphoma,Ependymoblastoma, Ependymoma, Epithelioid sarcoma, Erythroleukemia,Esophageal cancer, Esthesioneuroblastoma, Ewing Family of Tumor, EwingFamily Sarcoma, Ewing's sarcoma, Extracranial Germ Cell Tumor,Extragonadal Germ Cell Tumor, Extrahepatic Bile Duct Cancer,Extramammary Paget's disease, Fallopian tube cancer, Fetus in fetu,Fibroma, Fibrosarcoma, Follicular lymphoma, Follicular thyroid cancer,Gallbladder Cancer, Gallbladder cancer, Ganglioglioma, Ganglioneuroma,Gastric Cancer, Gastric lymphoma, Gastrointestinal cancer,Gastrointestinal Carcinoid Tumor, Gastrointestinal Stromal Tumor,Gastrointestinal stromal tumor, Germ cell tumor, Germinoma, Gestationalchoriocarcinoma, Gestational Trophoblastic Tumor, Giant cell tumor ofbone, Glioblastoma multiforme, Glioma, Gliomatosis cerebri, Glomustumor, Glucagonoma, Gonadoblastoma, Granulosa cell tumor, Hairy CellLeukemia, Hairy cell leukemia, Head and Neck Cancer, Head and neckcancer, Heart cancer, Hemangioblastoma, Hemangiopericytoma,Hemangiosarcoma, Hematological malignancy, Hepatocellular carcinoma,Hepatosplenic T-cell lymphoma, Hereditary breast-ovarian cancersyndrome, Hodgkin Lymphoma, Hodgkin's lymphoma, Hypopharyngeal Cancer,Hypothalamic Glioma, Inflammatory breast cancer, Intraocular Melanoma,Islet cell carcinoma, Islet Cell Tumor, Juvenile myelomonocyticleukemia, Kaposi Sarcoma, Kaposi's sarcoma, Kidney Cancer, Klatskintumor, Krukenberg tumor, Laryngeal Cancer, Laryngeal cancer, Lentigomaligna melanoma, Leukemia, Leukemia, Lip and Oral Cavity Cancer,Liposarcoma, Lung cancer, Luteoma, Lymphangioma, Lymphangiosarcoma,Lymphoepithelioma, Lymphoid leukemia, Lymphoma, Macroglobulinemia,Malignant Fibrous Histiocytoma, Malignant fibrous histiocytoma,Malignant Fibrous Histiocytoma of Bone, Malignant Glioma, MalignantMesothelioma, Malignant peripheral nerve sheath tumor, Malignantrhabdoid tumor, Malignant triton tumor, MALT lymphoma, Mantle celllymphoma, Mast cell leukemia, Mediastinal germ cell tumor, Mediastinaltumor, Medullary thyroid cancer, Medulloblastoma, Medulloblastoma,Medulloepithelioma, Melanoma, Melanoma, Meningioma, Merkel CellCarcinoma, Mesothelioma, Mesothelioma, Metastatic Squamous Neck Cancerwith Occult Primary, Metastatic urothelial carcinoma, Mixed Mülleriantumor, Monocytic leukemia, Mouth Cancer, Mucinous tumor, MultipleEndocrine Neoplasia Syndrome, Multiple Myeloma, Multiple myeloma,Mycosis Fungoides, Mycosis fungoides, Myelodysplastic Disease,Myelodysplastic Syndromes, Myeloid leukemia, Myeloid sarcoma,Myeloproliferative Disease, Myxoma, Nasal Cavity Cancer, NasopharyngealCancer, Nasopharyngeal carcinoma, Neoplasm, Neurinoma, Neuroblastoma,Neuroblastoma, Neurofibroma, Neuroma, Nodular melanoma, Non-HodgkinLymphoma, Non-Hodgkin lymphoma, Nonmelanoma Skin Cancer, Non-Small CellLung Cancer, Ocular oncology, Oligoastrocytoma, Oligodendroglioma,Oncocytoma, Optic nerve sheath meningioma, Oral Cancer, Oral cancer,Oropharyngeal Cancer, Osteosarcoma, Osteosarcoma, Ovarian Cancer,Ovarian cancer, Ovarian Epithelial Cancer, Ovarian Germ Cell Tumor,Ovarian Low Malignant Potential Tumor, Paget's disease of the breast,Pancoast tumor, Pancreatic Cancer, Pancreatic cancer, Papillary thyroidcancer, Papillomatosis, Paraganglioma, Paranasal Sinus Cancer,Parathyroid Cancer, Penile Cancer, Perivascular epithelioid cell tumor,Pharyngeal Cancer, Pheochromocytoma, Pineal Parenchymal Tumor ofIntermediate Differentiation, Pineoblastoma, Pituicytoma, Pituitaryadenoma, Pituitary tumor, Plasma Cell Neoplasm, Pleuropulmonaryblastoma, Polyembryoma, Precursor T-lymphoblastic lymphoma, Primarycentral nervous system lymphoma, Primary effusion lymphoma, PrimaryHepatocellular Cancer, Primary Liver Cancer, Primary peritoneal cancer,Primitive neuroectodermal tumor, Prostate cancer, Pseudomyxomaperitonei, Rectal Cancer, Renal cell carcinoma, Respiratory TractCarcinoma Involving the NUT Gene on Chromosome 15, Retinoblastoma,Rhabdomyoma, Rhabdomyosarcoma, Richter's transformation, Sacrococcygealteratoma, Salivary Gland Cancer, Sarcoma, Schwannomatosis, Sebaceousgland carcinoma, Secondary neoplasm, Seminoma, Serous tumor,Sertoli-Leydig cell tumor, Sex cord-stromal tumor, Sézary Syndrome,Signet ring cell carcinoma, Skin Cancer, Small blue round cell tumor,Small cell carcinoma, Small Cell Lung Cancer, Small cell lymphoma, Smallintestine cancer, Soft tissue sarcoma, Somatostatinoma, Soot wart,Spinal Cord Tumor, Spinal tumor, Splenic marginal zone lymphoma,Squamous cell carcinoma, Stomach cancer, Superficial spreading melanoma,Supratentorial Primitive Neuroectodermal Tumor, Surfaceepithelial-stromal tumor, Synovial sarcoma, T-cell acute lymphoblasticleukemia, T-cell large granular lymphocyte leukemia, T-cell leukemia,T-cell lymphoma, T-cell prolymphocytic leukemia, Teratoma, Terminallymphatic cancer, Testicular cancer, Thecoma, Throat Cancer, ThymicCarcinoma, Thymoma, Thyroid cancer, Transitional Cell Cancer of RenalPelvis and Ureter, Transitional cell carcinoma, Urachal cancer, Urethralcancer, Urogenital neoplasm, Uterine sarcoma, Uveal melanoma, VaginalCancer, Verner Morrison syndrome, Verrucous carcinoma, Visual PathwayGlioma, Vulvar Cancer, Waldenström's macroglobulinemia, Warthin's tumor,Wilms' tumor, and combination thereof. In one embodiment, the cancer isColorectal Cancer, Non-Small Cell Lung Cancer, Cholangiocarcinoma,Mesothelioma, Castleman's disease, Renal Cell Carcinoma, or anycombination thereof. In one embodiment, the patient may have a cancerselected from head and neck cancer, esophageal cancer, throat cancer,lung cancer, gastrointestinal cancers such as stomach cancer, colorectalcancer, pancreatic cancer, as well as hematological cancers such asmultiple myeloma, leukemia, and lymphoma.

In one embodiment, the patient suffers from a disease or disorderselected from the group consisting of general fatigue, exercise-inducedfatigue, cancer-related fatigue, inflammatory disease-related fatigue,chronic fatigue syndrome, cancer-related cachexia, cardiac-relatedcachexia, respiratory-related cachexia, renal-related cachexia,age-related cachexia, rheumatoid arthritis, systemic lupus erythematosis(SLE), systemic juvenile idiopathic arthritis, psoriasis, psoriaticarthropathy, ankylosing spondylitis, inflammatory bowel disease (IBD),polymyalgia rheumatica, giant cell arteritis, autoimmune vasculitis,graft versus host disease (GVHD), Sjogren's syndrome, adult onsetStill's disease, rheumatoid arthritis, systemic juvenile idiopathicarthritis, osteoarthritis, osteoporosis, Paget's disease of bone,osteoarthritis, multiple myeloma, Hodgkin's lymphoma, non-Hodgkin'slymphoma, prostate cancer, leukemia, renal cell cancer, multicentricCastleman's disease, ovarian cancer, drug resistance in cancerchemotherapy, cancer chemotherapy toxicity, ischemic heart disease,atherosclerosis, obesity, diabetes, asthma, multiple sclerosis,Alzheimer's disease, cerebrovascular disease, fever, acute phaseresponse, allergies, anemia, anemia of inflammation (anemia of chronicdisease), hypertension, depression, depression associated with a chronicillness, thrombosis, thrombocytosis, acute heart failure, metabolicsyndrome, miscarriage, obesity, chronic prostatitis, glomerulonephritis,pelvic inflammatory disease, reperfusion injury, transplant rejection,graft versus host disease (GVHD), avian influenza, smallpox, pandemicinfluenza, adult respiratory distress syndrome (ARDS), severe acuterespiratory syndrome (SARS), sepsis, and systemic inflammatory responsesyndrome (SIRS).

In one embodiment, the patient has or is to receive autologous stem cellor bone marrow transplant.

In one embodiment, the IL-6 antagonist, optionally an anti-IL-6 antibodyor antibody fragment, may be administered prior, concurrent or afterchemotherapy or radiotherapy. In one embodiment, the chemotherapeutic isan EGFR inhibitor. In one embodiment, the EGFR inhibitor is selectedfrom the group consisting of Cetuximab (Erbitux), Erlotinib (Tarceva),Gefitinib (Iressa), Lapatinib (Tykerb), Panitimumab (Vectibox),Sunitinib or Sutent(N-(2-diethylaminoethyl)-5-[(Z)-(5-fluoro-2-oxo-1H-indol-3-ylidene)methyl]-2,4-dimethyl-1H-pyrrole-3-carboxamide),Gefitinib orN-(3-chloro-4-fluoro-phenyl)-7-methoxy-6-(3-morpholin-4-ylpropoxy)quinazolin-4-amine,and Zalutumumab. In one embodiment, the patient may have a cancer thathas exhibited resistance to said chemotherapeutic or radiation after atleast one round of chemotherapy or radiation. In one embodiment, thechemotherapeutic or radiation reduces or prevents the treated cancerfrom invading or metastasizing to other sites in the body. In oneembodiment, the chemotherapeutic or radiation results in increasedapoptosis of the treated cancer cells.

In one embodiment, the treated cancer is selected from advanced andnon-advanced cancers including metastasized cancers such as metastaticand non-metastatic lung cancer, breast cancer, head and neck cancer,(HNSCC), pharyngeal cancer, pancreatic cancer, colorectal cancer, analcancer, glioblastoma multiforme, epithelial cancers, renal cellcarcinomas, acute or chronic myelogenous leukemia and other leukemias.

In one embodiment, the results are used to facilitate design of anappropriate therapeutic regimen for mucositis or a disease associatedwith mucositis.

In one embodiment, the IL-6 antagonist, optionally an anti-IL-6 antibodyor antibody fragment, is co-administered with another therapeutic agentselected from the group consisting of analgesics, antibiotics,anti-cachexia agents, anti-coagulants, anti-cytokine agents, antiemeticagents, anti-fatigue agent, anti-fever agent, anti-inflammatory agents,anti-nausea agents, antipyretics, antiviral agents, anti-weakness agent,chemotherapy agents, cytokine antagonist, cytokines, cytotoxic agents,gene therapy agents, growth factors, IL-6 antagonists, immunosuppressiveagents, local anesthetic, statins, other therapeutic agents, or anycombination thereof.

In another embodiment, the analgesic is acetaminophen, amitriptyline,benzocaine, carbamazepine, codeine, dyclonine hydrochloride (HCl),dihydromorphine, fentanyl patch, Flupirtine, fluriprofen, gabapentin,hydrocodone APAP, hydromorphone, ibuprofen, ketoprofen, lidocaine,morphine, an opiate and derivatives thereof, oxycodone, pentazocine,pethidine, phenacetin, pregabalin, propoeylphene, propoyl APA,salicylamide, tramadol, tramadol APAP, Ulcerease® (0.6% Phenol), orvoltaren.

In another embodiment, the local anesthetic is amethocaine, articaine,benzocaine, bupivacaine, mepivacaine, cocaine, cinchocaine,chloroprocaine, cyclomethycaine, dibucaine, dimethocaine, EMLA®(eutectic mixture of lidocaine and prilocalne), etidocaine, larocaine,levobupivacaine, lidocaine, lignocaine, procaine, piperocaine,prilocalne, proparacaine, propoxycaine, ropivacaine, saxitoxin,tetracaine, tetrodotoxin, or trimecaine.

In another embodiment, the anti-cachexia agent is cannabis, dronabinol(Marinol®), nabilone (Cesamet), cannabidiol, cannabichromene,tetrahydrocannabinol, Sativex, megestrol acetate, or any combinationthereof.

In another embodiment, the anti-coagulant is abciximab (ReoPro®),acenocoumarol, antithrombin III, argatroban, aspirin, bivalirudin(Angiomax®), clopidogrel, dabigatran, dabigatran etexilate(Pradaxa®/Pradax®), desirudin (Revasc®/Iprivask®), dipyridamole,eptifibatide (Integrilin®), fondaparinux, heparin, hirudin, idraparinux,lepirudin (Refludan®), low molecular weight heparin, melagatran,phenindione, phenprocoumon, ticlopidine, tirofiban (Aggrastat®),warfarin, ximelagatran, ximelagatran (Exanta®/Exarta®), or anycombination thereof.

In another embodiment, the anti-inflammatory agent is acetaminophen,azapropazone, diclofenac, diflunisal, etodolac, fenbufen, fenoprofen,flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, mefenamic,meloxicam, nabumetone, naproxen, phenylbutazone, piroxicam, asalicylate, sulindac, tenoxicam, tiaprofenic acid, or tolfenamic acid.In still further embodiment, the salicylate is acetylsalicylic acid,amoxiprin, benorylate, choline magnesium salicylate, ethenzamide,faislamine, methyl salicylate, magnesium salicylate, salicyl salicylate,or salicylamide.

In another embodiment, the anti-nausea agent or antiemetic agent iscomprising 5-HT3 receptor antagonists, ajwain, alizapride,anticholinergics, antihistamines, aprepitant, benzodiazepines,cannabichromene, cannabidiol, cannabinoids, cannabis, casopitant,chlorpromazine, cyclizine, dexamethasone, dexamethasone, dimenhydrinate(Gravol®), diphenhydramine, dolasetron, domperidone, dopamineantagonists, doxylamine, dronabinol (Marinol®), droperidol, emetrol,ginger, granisetron, haloperidol, hydroxyzine, hyoscine, lorazepam,meclizine, metoclopramide, midazolam, muscimol, nabilone (Cesamet), nk1receptor antagonists, ondansetron, palonosetron, peppermint, Phenergan,prochlorperazine, Promacot, promethazine, Pentazine, propofol, sativex,tetrahydrocannabinol, trimethobenzamide, tropisetron, nandrolone,stilbestrol, thalidomide, lenalidomide, ghrelin agonists, myostatinantagonists, anti-myostatin antibodies, selective androgen receptormodulators, selective estrogen receptor modulators, angiotensin Allantagonists, beta two adenergic receptor agonists, beta three adenergicreceptor agonists, or any combination thereof.

In another embodiment, the antiviral agent is selected from the groupconsisting of abacavir, aciclovir, acyclovir, adefovir, amantadine,amprenavir, an antiretroviral fixed dose combination, an antiretroviralsynergistic enhancer, arbidol, atazanavir, atripla, brivudine,cidofovir, combivir, darunavir, delavirdine, didanosine, docosanol,edoxudine, efavirenz, emtricitabine, enfuvirtide, entecavir, entryinhibitors, famciclovir, fomivirsen, fosamprenavir, foscarnet, fosfonet,fusion inhibitor, ganciclovir, gardasil, ibacitabine, idoxuridine,imiquimod, immunovir, indinavir, inosine, integrase inhibitor,interferon, interferon type I, interferon type II, interferon type III,lamivudine, lopinavir, loviride, maraviroc, MK-0518, moroxydine,nelfinavir, nevirapine, nexavir, nucleoside analogues, oseltamivir,penciclovir, peramivir, pleconaril, podophyllotoxin, protease inhibitor,reverse transcriptase inhibitor, ribavirin, rimantadine, ritonavir,saquinavir, stavudine, tenofovir, tenofovir disoproxil, tipranavir,trifluridine, trizivir, tromantadine, truvada, valaciclovir,valganciclovir, vicriviroc, vidarabine, viramidine, zalcitabine,zanamivir, zidovudine, or any combination thereof.

In another embodiment, the cytotoxic agent, chemotherapeutic agent, orimmunosuppressive agent is comprising 1-dehydrotestosterone,1-methylnitrosourea, 5-fluorouracil, 6-mercaptopurine, 6-mercaptopurine,6-thioguanine, Abatacept, abraxane, acitretin, aclarubicin, Actinium-225(²²⁵Ac), actinomycin, Adalimumab, adenosine deaminase inhibitors,Afelimomab, Aflibercept, Afutuzumab, Alefacept, alitretinoin, alkylsulfonates, alkylating agents, altretamine, alvocidib, aminolevulinicacid/methyl aminolevulinate, aminopterin, aminopterin, amrubicin,amsacrine, amsacrine, anagrelide, Anakinra, anthracenediones,anthracyclines, anthracyclines, anthracyclines, anthramycin (AMC);antimytotic agents, antibiotics, anti-CD20 antibodies, antifolates,Anti-lymphocyte globulin, Antimetabolites, Anti-thymocyte globulin,arsenic trioxide, Aselizumab, asparaginase, asparagine depleters,Astatine-211 (²¹¹At) Atlizumab, Atorolimumab, atrasentan, Avastin®,azacitidine, Azathioprine, azelastine, aziridines, Basiliximab, BAYXantibodies, Belatacept, Belimumab, belotecan, bendamustine,Bertilimumab, bexarotene, bisantrene, Bismuth-213 (²¹³Bi), Bismuth-212(²¹²Bi), bleomycin, bleomycin, bleomycin, BLyS antibodies, bortezomib,busulfan, busulfan, Calcineurin inhibitors, calicheamicin, camptothecin,camptothecins, capecitabine, carboplatin (paraplatin), carboquone,caminomycin, carmofur, carmustine, carmustine (BSNU), CAT antibodies,CD11a antibodies, CD147/Basigin antibodies, CD154 antibodies, CD18antibodies, CD20 antibodies, CD23 antibodies, CD3 antibodies, CD4antibodies, CD40 antibodies, CD62L/L-selectin antibodies, CD80antibodies, CDK inhibitors, Cedelizumab, celecoxib, Certolizumab pegol,chlorambucil, chlorambucils, Ciclosporin, cis-dichlorodiamine platinum(II) (DDP) cisplatin, cladribine, Clenoliximab, clofarabine, colchicin,Complement component 5 antibodies, Copper-67 (⁶⁷Cu), corticosteroids,CTLA-4 antibodies, CTLA-4 fusion proteins, Cyclophilin inhibitors,cyclophosphamides, cyclothosphamide, cytarabine, cytarabine,cytochalasin B, cytotoxic ribonucleases, dacarbazine, Daclizumab,dactinomycin, dactinomycin (actinomycin D), daunorubicin, daunorubicin,daunorubicin (formerly daunomycin), decitabine, Deforolimus,demecolcine, detorubicin, dibromomannitol, diethylcarbamazine,dihydrofolate reductase inhibitors, dihydroxy anthracin dione,diphtheria toxin, DNA polymerase inhibitors, docetaxel, Dorlimomabaritox, Dorlixizumab, doxorubicin (adriamycin), DXL625, Eculizumab,Efalizumab, efaproxiral, EGFR antagonists, elesclomol, elsamitrucin,Elsilimomab, emetine, endothelin receptor antagonists,epipodophyllotoxins, epirubicin, epothilones, Erbitux®, Erlizumab,estramustine, Etanercept, ethidium bromide, etoglucid, etoposide,etoposide phosphate, Everolimus, Faralimomab, farnesyltransferaseinhibitors, FKBP inhibitors, floxuridine, fludarabine, fluorouracil,Fontolizumab, fotemustine, Galiximab, Gallium-67 (⁶⁷Ga), Gantenerumab,Gavilimomab, gemcitabine, glucocorticoids, Golimumab, Gomiliximab,gramicidin D, Gusperimus, Herceptin®, hydrazines, hydroxyurea,hypomethylating agents, idarubicin, Idarubicine, ifosfamide, IL-1antagonists, IL-1 receptor antagonists, IL-12, IL-12 antibodies, IL-12Rantagonists, IL-13 antibodies, IL-2, IL-2 inhibitors, IL-2 receptor/CD25antibodies, IL-6 antibodies, imatinib mesylate, Immunoglobulin Eantibodies, IMP dehydrogenase inhibitors, Infliximab, Inolimomab,Integrin antibodies, Interferon antibodies, interferons, Interleukin 5antibodies, Interleukin-6 receptor antibodies, interleukins, Iodine-125(¹²⁵I), Iodine-131 (¹³¹I), Ipilimumab, irinotecan, ixabepilone,Keliximab, larotaxel, Lead-212 (²¹²Pb), Lebrilizumab, Leflunomide,Lenalidomide, Lerdelimumab, leucovorine, LFA-1 antibodies, lidocaine,lipoxygenase inhibitors, lomustine (CCNU), lonidamine, lucanthone,Lumiliximab, Lutetium-177 (¹⁷⁷Lu), Macrolides, mannosulfan, Maslimomab,masoprocol, mechlorethamine, melphalan, Mepolizumab, mercaptopurine,Metelimumab, Methotrexate, microtubule assembly inhibitors, microtubulestability enhancers, mithramycin, mitobronitol, mitoguazone, mitomycin,mitomycin C, mitotane, mitoxantrone, Morolimumab, mTOR inhibitors,Muromonab-CD3, mustines, Mycophenolic acid, mytotane (O,P′-(DDD)),Natalizumab, nedaplatin, Nerelimomab, nimustine, nitrogen mustards,nitrosoureas, nordihydroguaiaretic acid, oblimersen, ocrelizumab,Ocrelizumab, Odulimomab, ofatumumab, olaparib, Omalizumab, ortataxel,Otelixizumab, oxaliplatin, oxaliplatin, paclitaxel (taxol),Pascolizumab, PDGF antagonists, pegaspargase, pemetrexed, Pentostatin,Pertuzumab, Pexelizumab, phosphodiesterase inhibitors, Phosphorus-32(³²P), Pimecrolimus Abetimus, pirarubicin, pixantrone, platins,plicamycin, poly ADP ribose polymerase inhibitors, porfimer sodium,porphyrin derivatives, prednimustine, procaine, procarbazine,procarbazine, propranolol, proteasome inhibitors, pseudomonas exotoxin,Pseudomonas toxin, purine synthesis inhibitors, puromycin, pyrimidinesynthesis inhibitors, radionuclides, radiotherapy, raltitrexed,ranimustine, Reslizumab, retinoid X receptor agonists, retinoids,Rhenium-186 (¹⁸⁶Re), Rhenium-188 (¹⁸⁸Re), ribonucleotide reductaseinhibitors, ricin, Rilonacept, Rituxan®, Rovelizumab, rubitecan,Ruplizumab, Samarium-153 (¹⁵³Sm), satraplatin, Scandium-47 (⁴⁷Sc),selective androgen receptor modulators, selective estrogen receptormodulators, seliciclib, semustine, sex hormone antagonists, siplizumab,sirolimus, steroid aromatase inhibitors, steroids, streptozocin,streptozotocin, Tacrolimus, talaporfin, Talizumab, taxanes, taxols,tegafur, Telimomab aritox, temoporfin, temozolomide, temsirolimus,Temsirolimus, Teneliximab, teniposide, Teplizumab, Teriflunomide,tesetaxel, testolactone, tetracaine, Thalidomide, thioepa chlorambucil,thiopurines thioguanine, ThioTEPA, thymidylate synthase inhibitors,tiazofurin, tipifarnib, T-lymphocyte antibodies, TNF antagonists, TNFantibodies, TNF fusion proteins, TNF receptor fusion proteins, TNF-alphainhibitors, Tocilizumab, topoisomerase inhibitors, topotecan,Toralizumab, trabectedin, Tremelimumab, treosulfan, tretinoin,triazenes, triaziquone, triethylenemelamine, triplatin tetranitrate,trofosfamide, tumor antigen specific monoclonal antibodies, tyrosinekinase inhibitors, uramustine, Ustekinumab, valrubicin, Valrubicine,Vapaliximab, VEGF antagonists, Vepalimomab, verteporfin, vinblastine,vinca alkaloids, vincristine, vindesine, vinflunine, vinorelbine,Visilizumab, vorinostat, Yttrium-88 (⁸⁸Y), Yttrium-90 (⁹⁰Y),Zanolimumab, zileuton, Ziralimumab, Zolimomab aritox, zorubicin,Zotarolimus, or any combination thereof.

In another embodiment, the chemotherapy agent is selected from the groupconsisting of VEGF antagonists, EGFR antagonists, platins includingcisplatin and carboplatin, taxols, irinotecan, 5-fluorouracil,gemcytabine, leucovorine, steroids, cyclophosphamide, melphalan, vincaalkaloids, vinblastine, vincristine, vindesine, vinorelbine, mustines,tyrosine kinase inhibitors, radiotherapy, sex hormone antagonists,selective androgen receptor modulators, selective estrogen receptormodulators, PDGF antagonists, TNF antagonists, IL-1 antagonists,interleukins, IL-12, IL-2, IL-12R antagonists, Toxin conjugatedmonoclonal antibodies, tumor antigen specific monoclonal antibodies,Erbitux®, Avastin®, Pertuzumab, anti-CD20 antibodies, Rituxan®,ocrelizumab, ofatumumab, DXL625, Herceptin®, or any combination thereof.

In another embodiment, the cytokine antagonist is an antagonist of tumornecrosis factor-alpha, interferon gamma, interleukin 1 alpha,interleukin 1 beta, interleukin 6, TNF-α, IL-1α, IL-1β, IL-2, IL-4,IL-6, IL-10, IL-12, IL-13, IL-18, IFN-α, IFN-γ, BAFF, CXCL13, IP-10,leukemia-inhibitory factor, or a combination thereof.

In another embodiment, the growth factor is VEGF, EPO, EGF, HRG,Hepatocyte Growth Factor (HGF), Hepcidin, or any combination thereof.

In another embodiment, the statin is comprising atorvastatin,cerivastatin, fluvastatin, lovastatin, mevastatin, pitavastatin,pravastatin, rosuvastatin, simvastatin, or any combination thereof.

In another embodiment, the other therapeutic agent is an antagonist of afactor comprising tumor necrosis factor-alpha, Interferon gamma,Interleukin 1 alpha, Interleukin 1 beta, Interleukin 6, proteolysisinducing factor, leukemia-inhibitory factor, tamoxifen, BCL-2antagonists, estrogen, bisphosphonates, teriparatide, strontiumranelate, sodium alendronate (Fosamax), risedronate (Actonel),raloxifene, ibandronate (Boniva), Obatoclax, ABT-263, gossypol,gefitinib, epidermal growth factor receptor tyrosine kinase inhibitors,erlotinib, epidermal growth factor receptor inhibitors, psoralens,trioxysalen, methoxsalen, bergapten, retinoids, etretinate, acitretin,infliximab (Remicade®), adalimumab, infliximab, etanercept, Zenapax®,Cyclosporine, Methotrexate, granulocyte-colony stimulating factor,filgrastim, lenograstim, Neupogen, Neulasta, 2-Arylpropionic acids,Aceclofenac, Acemetacin, Acetylsalicylic acid (Aspirin), Alclofenac,Alminoprofen, Amoxiprin, Ampyrone, Arylalkanoic acids, Azapropazone,Benorylate/Benorilate, Benoxaprofen, Bromfenac, Carprofen, Celecoxib,Choline magnesium salicylate, Clofezone, COX-2 inhibitors, Dexibuprofen,Dexketoprofen, Diclofenac, Diflunisal, Droxicam, Ethenzamide, Etodolac,Etoricoxib, Faislamine, fenamic acids, Fenbufen, Fenoprofen, Flufenamicacid, Flunoxaprofen, Flurbiprofen, Ibuprofen, Ibuproxam, Indometacin,Indoprofen, Kebuzone, Ketoprofen, Ketorolac, Lornoxicam, Loxoprofen,Lumiracoxib, Magnesium salicylate, Meclofenamic acid, Mefenamic acid,Meloxicam, Metamizole, Methyl salicylate, Mofebutazone, Nabumetone,Naproxen, N-Arylanthranilic acids, Oxametacin, Oxaprozin, Oxicams,Oxyphenbutazone, Parecoxib, Phenazone, Phenylbutazone, Phenylbutazone,Piroxicam, Pirprofen, profens, Proglumetacin, Pyrazolidine derivatives,Rofecoxib, Salicyl salicylate, Salicylamide, Salicylates,Sulfinpyrazone, Sulindac, Suprofen, Tenoxicam, Tiaprofenic acid,Tolfenamic acid, Tolmetin, and Valdecoxib. Antibiotics include Amikacin,Aminoglycosides, Amoxicillin, Ampicillin, Ansamycins, Arsphenamine,Azithromycin, Azlocillin, Aztreonam, Bacitracin, Carbacephem,Carbapenems, Carbenicillin, Cefaclor, Cefadroxil, Cefalexin, Cefalothin,Cefalotin, Cefamandole, Cefazolin, Cefdinir, Cefditoren, Cefepime,Cefixime, Cefoperazone, Cefotaxime, Cefoxitin, Cefpodoxime, Cefprozil,Ceftazidime, Ceftibuten, Ceftizoxime, Ceftobiprole, Ceftriaxone,Cefuroxime, Cephalosporins, Chloramphenicol, Cilastatin, Ciprofloxacin,Clarithromycin, Clindamycin, Cloxacillin, Colistin, Co-trimoxazole,Dalfopristin, Demeclocycline, Dicloxacillin, Dirithromycin, Doripenem,Doxycycline, Enoxacin, Ertapenem, Erythromycin, Ethambutol,Flucloxacillin, Fosfomycin, Furazolidone, Fusidic acid, Gatifloxacin,Geldanamycin, Gentamicin, Glycopeptides, Herbimycin, Imipenem,Isoniazid, Kanamycin, Levofloxacin, Lincomycin, Linezolid, Lomefloxacin,Loracarbef, Macrolides, Mafenide, Meropenem, Meticillin, Metronidazole,Mezlocillin, Minocycline, Monobactams, Moxifloxacin, Mupirocin,Nafcillin, Neomycin, Netilmicin, Nitrofurantoin, Norfloxacin, Ofloxacin,Oxacillin, Oxytetracycline, Paromomycin, Penicillin, Penicillins,Piperacillin, Platensimycin, Polymyxin B, Polypeptides, Prontosil,Pyrazinamide, Quinolones, Quinupristin, Rifampicin, Rifampin,Roxithromycin, Spectinomycin, Streptomycin, Sulfacetamide,Sulfamethizole, Sulfanilimide, Sulfasalazine, Sulfisoxazole,Sulfonamides, Teicoplanin, Telithromycin, Tetracycline, Tetracyclines,Ticarcillin, Timidazole, Tobramycin, Trimethoprim,Trimethoprim-Sulfamethoxazole, Troleandomycin, Trovafloxacin, andVancomycin. Active agents also include Aldosterone, Beclometasone,Betamethasone, Corticosteroids, Cortisol, Cortisone acetate,Deoxycorticosterone acetate, Dexamethasone, Fludrocortisone acetate,Glucocorticoids, Hydrocortisone, Methylprednisolone, Prednisolone,Prednisone, Steroids, and Triamcinolone, an agonist, antagonist, ormodulator of a factor comprising TNF-alpha, IL-2, IL-4, IL-6, IL-10,IL-12, IL-13, IL-18, IFN-alpha, IFN-gamma, BAFF, CXCL13, IP-10, VEGF,EPO, EGF, HRG, Hepatocyte Growth Factor (HGF), Hepcidin, or anycombination thereof.

In one embodiment, the IL-6 antagonist comprises anti-IL-6 antibodies orantibody fragments thereof, antisense nucleic acids, polypeptides, smallmolecules, or any combination thereof. In another embodiment, theantisense nucleic acid comprises at least approximately 10 nucleotidesof a sequence encoding IL-6, IL-6 receptor alpha, gp130, p38 MAP kinase,JAK1, JAK2, JAK3, STAT3, or SYK. In another embodiment, the antisensenucleic acid comprises DNA, RNA, peptide nucleic acid, locked nucleicacid, morpholino (phosphorodiamidate morpholino oligo), glycerol nucleicacid, threose nucleic acid, or any combination thereof. In anotherembodiment, the IL-6 antagonist polypeptide comprises a fragment of apolypeptide having a sequence selected from the group consisting solubleIL-6, IL-6 receptor alpha, gp130, p38 MAP kinase, JAK1, JAK2, JAK3,STAT3, and SYK.

In one embodiment, the antibody or antibody fragment may be directly orindirectly coupled to a detectable label, half-life increasing moiety,cytotoxic agent, therapeutic agent, or an immunosuppressive agent. Inanother embodiment, the detectable label is comprising fluorescent dyes,bioluminescent materials, radioactive materials, chemiluminescentmoieties, streptavidin, avidin, biotin, radioactive materials, enzymes,substrates, horseradish peroxidase, acetylcholinesterase, alkalinephosphatase, β-galactosidase, luciferase, rhodamine, fluorescein,fluorescein isothiocyanate, umbelliferone, dichlorotriazinylamine,phycoerythrin, dansyl chloride, luminol, luciferin, aequorin, Iodine 125(¹²⁵I), Carbon 14 (¹⁴C), Sulfur 35 (³⁵S), Tritium (³H), Phosphorus 32(³²P), or any combination thereof.

In one embodiment, the subject may receive concomitant chemotherapy. Inanother embodiment, the subject may receive receiving concomitantradiotherapy.

In another embodiment, the antibody may be the Ab1 antibody.

In another embodiment, the composition may be administered intravenouslyfor at least about 1 hour. In another embodiment, the effective amountis or medicament comprises between about 0.1 and 20 mg/kg of body weightof recipient subject of said IL-6 antagonist. In another embodiment, theeffective amount is or medicament comprises at least about 25, 80, 100,160, 200, or 320 mg. In another embodiment, the effective amount is ormedicament comprises between about 0.1 and 100 mg/kg of body weight ofthe subject.

In another embodiment, the subject may be administered at least 1, 2, 3,4, or 5 doses. In another embodiment, the composition may beadministered every 4 weeks. In another embodiment, the composition maybe administered administered 160 mg every 4 weeks for a total of 2doses. In another embodiment, the composition may be administeredadministered 160 mg every 4 weeks for a total of 2 doses. In anotherembodiment, the composition may be administered administered 320 mgevery 4 weeks for a total of 2 doses.

In another embodiment, the oral and oropharyngeal mucositis may beinduced by chemoradiation (CRT) regimens or HSCT used for the treatmentof cancers of the head and neck.

In another embodiment, the method may further comprise assessment of thestatus of the oral mucositis or head and neck cancer.

In another embodiment, the assessment may comprise imaging modalityselected from the group consisting of CAT, PET, and MRI exams.

In another embodiment, the subject may be administered 5-fluoracil(5-FU) or Irinotecan.

The invention also provides a method of identifying cancers that arepotentially resistant to the effects of a chemotherapeutic or radiationby assaying for IL-6 using an antibody according to the invention inorder to detect whether elevated IL-6 levels are present at the site ofthe treated cancer.

In another embodiment, a method for the reduction of oral mucositis insubjects with head and neck cancer receiving concomitant chemotherapyand radiotherapy comprises administering an effective amount of ahumanized monoclonal antibody that selectively binds IL-6.

In another embodiment, a method for the treating oral mucositis in asubject with head and neck cancer receiving concomitant chemotherapycomprises administering an effective amount of a humanized monoclonalantibody that selectively binds IL-6, wherein said antibody is Ab1.

In another embodiment, a method for the treating alimentary tractmucositis in a subject with head and neck cancer receiving concomitantchemotherapy comprises administering an effective amount of a humanizedmonoclonal antibody that selectively binds IL-6, wherein said antibodyis Ab1.

In another embodiment, a method for the treating gastrointestinal tractmucositis in a subject with head and neck cancer receiving concomitantchemotherapy comprises administering an effective amount of a humanizedmonoclonal antibody that selectively binds IL-6, wherein said antibodyis Ab1.

In another embodiment, the invention provides for the use of an antibodyaccording to the invention for preparing a diagnostic composition foridentifying cancers that are potentially resistant to the effects of achemotherapeutic or radiation by assaying for IL-6 in order to detectwhether elevated IL-6 levels are present at the site of the treatedcancer.

In another embodiment, the invention provides for the use of an antibodyaccording to the invention for preparing a composition for the reductionof oral mucositis in subjects with head and neck cancer receivingconcomitant chemotherapy and radiotherapy comprising administering aneffective amount of a humanized monoclonal antibody that selectivelybinds IL-6.

In another embodiment, the invention provides for the use of an antibodyaccording to the invention for preparing a composition for the treatingoral mucositis in a subject with head and neck cancer receivingconcomitant chemotherapy comprising administering an effective amount ofa humanized monoclonal antibody that selectively binds IL-6, whereinsaid antibody is Ab1.

In another embodiment, the invention provides for the use of an antibodyaccording to the invention for preparing a composition for the treatingmucositis in a subject with head and neck cancer receiving concomitantchemotherapy comprising administering an effective amount of a humanizedmonoclonal antibody that selectively binds IL-6, wherein said antibodyis Ab1.

In one embodiment, the composition may be administered subcutaneously.In another embodiment, the composition may be a pharmaceuticalcomposition. In a further embodiment, the composition may be formulatedfor subcutanteous administration.

In one embodiment, the patient may have an elevated C-reactive protein(“CRP”). In one embodiment, the patient may have an elevated IL-6 serumlevel. In one embodiment, the patient may have an elevated IL-6 level inthe joints. In one embodiment, the patient may have had an inadequateresponse to non-steroidal anti-inflammatory drugs (NSAIDs). In oneembodiment, the patient may have had an inadequate response tonon-biologic Disease Modifying Anti-Rheumatic Drugs (DMARDs).

In one embodiment, the antibody or antibody fragment may be directly orindirectly coupled to a detectable label, cytotoxic agent, therapeuticagent, or an immunosuppressive agent. In one embodiment, the detectablelabel may comprise a fluorescent dye, bioluminescent material,radioactive material, chemiluminescent moietie, streptavidin, avidin,biotin, radioactive material, enzyme, substrate, horseradish peroxidase,acetylcholinesterase, alkaline phosphatase, β-galactosidase, luciferase,rhodamine, fluorescein, fluorescein isothiocyanate, umbelliferone,dichlorotriazinylamine, phycoerythrin, dansyl chloride, luminol,luciferin, aequorin, Iodine 125 (¹²⁵I), Carbon 14 (¹⁴C), Sulfur 35(³⁵S), Tritium (³H), Phosphorus 32 (³²P), or any combination thereof. Inanother embodiment, the IL-6 antagonist may be coupled to a half-lifeincreasing moiety.

In one embodiment, the antibody or antibody fragment may beco-administered with another therapeutic agent selected from the groupconsisting of analgesics, antibiotics, anti-cachexia agents,anti-coagulants, anti-cytokine agents, antiemetic agents, anti-fatigueagent, anti-fever agent, anti-inflammatory agents, anti-nausea agents,antipyretics, antiviral agents, anti-weakness agent, chemotherapyagents, cytokine antagonist, cytokines, cytotoxic agents, gene therapyagents, growth factor, IL-6 antagonists, immunosuppressive agents,statins, or any combination thereof. In one embodiment, the cytokineantagonist may be an antagonist of a factor comprising tumor necrosisfactor-alpha, interferon gamma, interleukin 1 alpha, interleukin 1 beta,interleukin 6, or any combination thereof. In one embodiment, thecytokine antagonist may be an antagonist of TNF-α, IL-1β, IL-2, IL-4,IL-6, IL-10, IL-12, IL-13, IL-18, IFN-α, IFN-γ, BAFF, CXCL13, IP-10,leukemia-inhibitory factor, or a combination thereof. In one embodiment,the growth factor may be VEGF, EPO, EGF, HRG, Hepatocyte Growth Factor(HGF), Hepcidin, or any combination thereof. In one embodiment, the IL-6antagonist may comprise an anti-IL-6 antibodies or antibody fragmentsthereof, antisense nucleic acids, polypeptides, small molecules, or anycombination thereof.

In another embodiment, the antisense nucleic acid may comprise at leastapproximately 10 nucleotides of a sequence encoding IL-6, IL-6 receptoralpha, gp130, p38 MAP kinase, JAK1, JAK2, JAK3, STAT3, or SYK. Inanother embodiment, the antisense nucleic acid may comprise DNA, RNA,peptide nucleic acid, locked nucleic acid, morpholino(phosphorodiamidate morpholino oligo), glycerol nucleic acid, threosenucleic acid, or any combination thereof. In another embodiment, theIL-6 antagonist polypeptide may comprise a fragment of a polypeptidehaving a sequence selected from the group consisting IL-6, IL-6 receptoralpha, gp130, p38 MAP kinase, JAK1, JAK2, JAK3, SYK, STAT3, or anycombination thereof. In a further embodiment, the IL-6 antagonist may bean anti-IL-6R, anti-gp130, anti-p38 MAP kinase, anti-JAK1, anti-JAK2,anti-JAK3, anti-STAT3, or anti-SYK antibody or antibody fragment

One embodiment encompasses specific humanized antibodies and fragmentsand variants thereof for treatment or prevention of mucositis capable ofbinding to IL-6 and/or the IL-6/IL-6R complex. These antibodies may bindsoluble IL-6 or cell surface expressed IL-6. Also, these antibodies mayinhibit the formation or the biological effects of at least one of IL-6,IL-6/IL-6R complexes, IL-6/IL-6R/gp130 complexes and/or multimers ofIL-6/IL-6R/gp130. The present invention relates to novel therapies andtherapeutic protocols using anti-IL-6 antibodies, preferably thosedescribed herein.

The invention also contemplates the administration of conjugates ofanti-IL-6 antibodies and humanized, chimeric or single chain versionsthereof and other binding fragments and variants thereof conjugated toat least one functional or detectable moieties.

In an embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may be directly or indirectly attached to adetectable label or therapeutic agent.

In one embodiment, the IL-6 antagonist may be an antisense nucleic acid.In another embodiment of the invention, the IL-6 antagonist may be anantisense nucleic acid, for example comprising at least approximately 10nucleotides of a sequence encoding IL-6, IL-6 receptor alpha, gp130, p38MAP kinase, JAK1, JAK2, JAK3, STAT3, or SYK. In a further embodiment ofthe invention, the antisense nucleic acid may comprise DNA, RNA, peptidenucleic acid, locked nucleic acid, morpholino (phosphorodiamidatemorpholino oligo), glycerol nucleic acid, threose nucleic acid, or anycombination thereof.

In one embodiment, the IL-6 antagonist may comprise Actemra®(Tocilizumab), Remicade®, Zenapax® (daclizumab), or any combinationthereof.

In one embodiment, the IL-6 antagonist may comprise a polypeptide havinga sequence comprising a fragment of IL-6, IL-6 receptor alpha, gp130,p38 MAP kinase, JAK1, JAK2, JAK3, SYK, or any combination thereof, suchas a fragment or full-length polypeptide that is at least 40 amino acidsin length. In another embodiment of the invention, the IL-6 antagonistmay comprise a soluble IL-6, IL-6 receptor alpha, gp130, p38 MAP kinase,JAK1, JAK2, JAK3, SYK, STAT3, or any combination thereof.

In another aspect the invention provides pharmaceutical compositions andtheir use in novel combination therapies and comprising administrationof an anti-IL-6 antibody, such as any one of Ab1-Ab36 antibodiesdescribed in Table 4 or a fragment or variant thereof, and at least oneother therapeutic compound such as an anti-cytokine agent.

In an embodiment of the invention, the IL-6 antagonist may target IL-6,IL-6 receptor alpha, gp130, p38 MAP kinase, JAK1, JAK2, JAK3, SYK, orany combination thereof. In one embodiment, the IL-6 antagonist maycomprise an antibody, an antibody fragment, a peptide, a glycoalkoid, anantisense nucleic acid, a ribozyme, a retinoid, an avemir, a smallmolecule, or any combination thereof. In one embodiment, the IL-6antagonist may comprise an anti-IL-6R, anti-gp130, anti-p38 MAP kinase,anti-JAK1, anti-JAK2, anti-JAK3, or anti-SYK antibody, anti-STAT3, orantibody fragment. In an embodiment of the invention, the antagonist maycomprise an anti-IL-6 antibody (e.g., any one of Ab1-Ab36 antibodiesdescribed in Table 4) or antibody fragment or variant thereof.

The present invention also pertains to methods of improvingsurvivability or quality of life of a patient having or at risk ofdeveloping mucositis comprising administering to the patient ananti-IL-6 antibody (e.g., ALD518 antibody) or antibody fragment orvariant thereof, whereby the patient's C-reactive protein (“CRP”) levelis lowered.

In one embodiment of the invention, the anti-IL-6 antibody or antibodyfragment or variant thereof may be administered to the patient with afrequency at most once per period of approximately 4, 8, 12, 16, 20, or24 weeks.

In an embodiment of the invention, the patient's quality of life may beimproved.

This invention relates to novel anti-IL-6 antibodies, novel therapiesand therapeutic protocols utilizing anti-IL-6 antibodies, andpharmaceutical formulations containing anti-IL-6 antibodies. Inpreferred embodiments, an anti-IL-6 antibody is any one of Ab1-Ab36antibodies described in Table 4, which includes rabbit or humanizedforms thereof, as well as heavy chains, light chains, fragments,variants, and CDRs thereof, or an antibody or antibody fragment thatspecifically binds to the same linear or conformational epitope(s) on anintact human IL-6 polypeptide fragment thereof as Ab1. The subjectapplication pertains in particular to preferred formulations andtherapeutic uses of an exemplary humanized antibody referred to hereinas any one of Ab1-Ab36 antibodies described in Table 4 and variantsthereof. In preferred embodiments, the anti-IL-6 antibody has an in vivohalf-life of at least about 30 days, has an in vivo effect of loweringC-reactive protein, possesses a binding affinity (Kd) for IL-6 of lessthan about 50 picomolar, and/or has a rate of dissociation (K_(off))from IL-6 of less than or equal to 10⁻⁴ S⁻¹.

In one aspect, this invention pertains to methods of improvingsurvivability or quality of life of a patient in need thereof,comprising administering to a patient with or at risk of developingmucositis as a result of disease or a therapeutic regimen comprising theadministration of an anti-IL-6 antibody, such as any one of Ab1-Ab36antibodies described in Table 4 antibody or a fragment or variantthereof (e.g., Ab1).

Another embodiment relates to methods of improving survivability orquality of life of a patient diagnosed with mucositis, comprisingadministering to the patient an anti-IL-6 antibody or antibody fragmentor variant thereof, whereby the patient's serum C-reactive protein(“CRP”) level is stabilized and preferably reduced, and monitoring thepatient to assess the reduction in the patient's serum CRP level. In anembodiment, the patient may have an elevated C-reactive protein (CRP)level prior to treatment. In an embodiment, the patient may have anelevated serum CRP level prior to treatment.

In an embodiment of the invention, the patient's serum CRP level mayremain decreased for an entire period intervening two consecutiveanti-IL-6 antibody administrations.

In one embodiment, the patient may have been diagnosed mucositis.

In one embodiment, the antibody, or antibody fragment thereof, may beexpressed from a recombinant cell. In another embodiment, the cell maybe selected from a mammalian, yeast, bacterial, and insect cell. Inanother embodiment, the cell may be a yeast cell. In another embodiment,the cell may be a diploidal yeast cell. In another embodiment, the yeastcell may be a Pichia yeast. In another embodiment, the anti-IL-6antibody may be produced in a yeast based (Pichia pastoris) expressionsystem using conventional fermentation processes and downstreampurification. In one embodiment, the antibodies and antibody fragmentsdescribed herein may be expressed in yeast cells. In one embodiment, themating competent yeast may a member of the Saccharomycetaceae family,which includes the genera Arxiozyma; Ascobotryozyma; Citeromyces;Debaryomyces; Dekkera; Eremothecium; Issatchenkia; Kazachstania;Kluyveromyces; Kodamaea; Lodderomyces; Pachysolen; Pichia;Saccharomyces; Saturnispora; Tetrapisispora; Torulaspora; Williopsis;and Zygosaccharomyces. Other types of yeast potentially useful in theinvention include Yarrowia, Rhodosporidium, Candida, Hansenula,Filobasium, Filobasidellla, Sporidiobolus, Bullera, Leucosporidium, andFilobasidella. In a preferred embodiment, the mating competent yeast maya member of the genus Pichia. In a further preferred embodiment, themating competent yeast of the genus Pichia is one of the followingspecies: Pichia pastoris, Pichia methanolica, and Hansenula polymorpha(Pichia angusta). In a particularly preferred embodiment, the matingcompetent yeast of the genus Pichia may the species Pichia pastoris.

In one embodiment, a composition for the reduction of oral mucositis insubjects with head and neck cancer receiving concomitant chemotherapyand radiotherapy may comprise an effective amount of a humanizedmonoclonal antibody that selectively binds IL-6.

In one embodiment, a composition for the treating oral mucositis in asubject with head and neck cancer receiving concomitant chemotherapy maycomprise an effective amount of a humanized monoclonal antibody thatselectively binds IL-6, wherein said antibody is Ab1.

In one embodiment, a composition comprising a humanized monoclonalantibody or fragment thereof that selectively binds IL-6 for treatingoral mucositis induced by chemoradiation (CRT) regimens used for thetreatment of cancers of the head and neck.

In one embodiment, a composition for treatment or prevention of oralmucositis may comprise a humanized monoclonal antibody that selectivelybinds IL-6 and saline solution.

In one embodiment, the oral mucositis may be induced by chemoradiation(CRT) regimens or HSCT regimens used for the treatment of cancers of thehead and neck.

In one embodiment, a method of treating rheumatoid arthritis bysubcutaneously administering a therapeutically effective dosage of ananti-IL-6 antibody or antibody fragment having the same epitopicspecificity as Ab1 or an antibody that competes with Ab1 for binding toIL-6 to a patient in need thereof.

In one embodiment, the invention provides for the use of anti-IL-6antibody or antibody fragment having the same epitopic specificity asAb1 or an antibody that competes with Ab1 for binding to IL-6 for thepreparation of a subcutaneously administrable composition for treatingrheumatoid arthritis in a patient in need thereof.

In a further embodiment, a composition for treating rheumatoid arthritismay comprise a therapeutically effective dosage of an anti-IL-6 antibodyor antibody fragment having the same epitopic specificity as Ab1 or anantibody that competes with Ab1 for binding to IL-6 to a patient in needthereof that is formulated for subcutaneous administration.

In one embodiment, the composition may comprise an anti-IL-6 antibody orantibody fragment contained in a composition that comprises, oralternatively consists of, said anti-IL-6 antibody or antibody fragment,about 5 mM Histidine base, about 5 mM Histidine HCl to make final pH 6,250 mM sorbitol, and 0.015% (w/w) Polysorbate 80.

In one embodiment, the composition may comprise an anti-IL-6 antibody orantibody fragment contained in a composition that comprises, oralternatively consists of, said anti-IL-6 antibody or antibody fragment,about 5 mM Histidine base, about 5 mM Histidine HCl to make final pH 6,250 to 280 mM sorbitol or sorbitol in combination with sucrose, and0.015% (w/w) Polysorbate 80, said formulation having a nitrogenheadspace in the shipping vials.

The invention also provides a composition for treating rheumatoidarthritis comprising a therapeutically effective dosage of an anti-IL-6antibody or antibody fragment having the same epitopic specificity asAb1 or an antibody that competes with Ab1 for binding to IL-6 to apatient in need thereof that is formulated for intravenousadministration.

In one embodiment, the composition may comprise an anti-IL-6 antibody orantibody fragment contained in a composition comprising, oralternatively consisting of, anti-IL-6 antibody or antibody fragment, 25mM Histidine base, Phosphoric acid q.s. to pH 6, and 250 mM sorbitol.

In one embodiment, the composition may comprise an anti-IL-6 antibody orantibody fragment contained in a composition comprising, oralternatively consisting of, said anti-IL-6 antibody or antibodyfragment, 12.5 mM Histidine base, 12.5 mM Histidine HCl (or 25 mMHistidine base and Hydrochloric acid q.s. to pH 6), 250 mM sorbitol, and0.015% (w/w) Polysorbate 80.

In one embodiment, the composition may comprise an anti-IL-6 antibody orantibody fragment contained in a composition comprising, oralternatively consisting of, said anti-IL-6 antibody or antibodyfragment, about 5 mM Histidine base, about 5 mM Histidine HCl to makefinal pH 6, 250 mM sorbitol, and 0.015% (w/w) Polysorbate 80.

In one embodiment, the composition may comprise a concentration of ananti-IL-6 antibody or antibody fragment is at least about 10, 20, 30,40, 50, 60, 70, 80, 90, 100 mg/mL or at least about 10-100 mg/mL.

In one embodiment, the composition may comprise at least about 50 or 100mg of an anti-IL-6 antibody or antibody fragment.

In one embodiment, the composition may comprise at least about 80 mg,about 160 mg, or about 320 mg of an anti-IL-6 antibody or antibodyfragment.

In one embodiment, the effective amount is between about 0.1 and 20mg/kg of body weight of recipient subject.

In one embodiment, the effective amount is between about 0.1 and 100mg/kg of body weight of the subject.

In one embodiment, the composition may comprise at least about 25, 80,100, 160, 200, or 320 mg.

In one embodiment, the composition may be formulated for intravenousadministration.

In one embodiment, the composition may comprise an excipient selectedfrom the group consisting of histidine, sorbitol, and polysorbate 80.

In one embodiment, the composition may be administered every 4 weeks. Inone embodiment, the composition may be administered 80 mg every 4 weeksfor a total of 2 doses. In one embodiment, the composition may beadministered 160 mg every 4 weeks for a total of 2 doses. In oneembodiment, the composition may be administered 320 mg every 4 weeks fora total of 2 doses.

In one embodiment, the anti-IL-6 antibody may comprise a light chainpolypeptide comprising a polypeptide having at least 75% identity, atleast 80% identity, at least 85% identity, at least 90% identity, atleast 95% identity, at least 96%, at least 97% identity, at least 98%,at least 99% identity, or 100% identity to SEQ ID NO: 709.

In one embodiment, the anti-IL-6 antibody may comprise a light chainpolypeptide comprising a polypeptide encoded by a polynucleotide thathas at least 75% identity, at least 80% identity, at least 85% identity,at least 90% identity, at least 95% identity, at least 96%, at least 97%identity, at least 98%, at least 99% identity, or 100% identity to SEQID NO: 723.

In one embodiment, the anti-IL-6 antibody may comprise a heavy chainpolypeptide comprising a polypeptide having at least 75% identity, atleast 80% identity, at least 85% identity, at least 90% identity, atleast 95% identity, at least 96%, at least 97% identity, at least 98%,at least 99% identity, or 100% identity to SEQ ID NO: 657.

In one embodiment, the anti-IL-6 antibody may comprise a heavy chainpolypeptide comprising a polypeptide encoded by a polynucleotide havingat least 75% identity, at least 80% identity, at least 85% identity, atleast 90% identity, at least 95% identity, at least 96%, at least 97%identity, at least 98%, at least 99% identity, or 100% identity to SEQID NO: 700.

In one embodiment, the anti-IL-6 antibody may comprise a light chainpolypeptide comprising: a polypeptide having at least 75% identity toSEQ ID NO: 709, a polypeptide encoded by a polynucleotide that has atleast 75% identity to the polynucleotide of SEQ ID NO: 723, apolypeptide encoded by a polynucleotide that hybridizes under mediumstringency conditions to a polynucleotide having the sequence of thereverse complement of SEQ ID NO: 723, or a polypeptide encoded by apolynucleotide that hybridizes under high stringency conditions to apolynucleotide having the sequence of the reverse complement of SEQ IDNO: 723; and a heavy chain polypeptide comprising: a polypeptide havingat least 75% identity to SEQ ID NO: 657, a polypeptide encoded by apolynucleotide that has at least 75% identity to the polynucleotide ofSEQ ID NO: 700, a polypeptide encoded by a polynucleotide thathybridizes under medium stringency conditions to a polynucleotide havingthe sequence of the reverse complement of SEQ ID NO: 700, or apolypeptide encoded by a polynucleotide that hybridizes under highstringency conditions to a polynucleotide having the sequence of thereverse complement of SEQ ID NO: 700; wherein the Ab1 antibody orantibody fragment specifically binds to IL-6 and antagonizes one or moreactivity associated with IL-6.

In one embodiment, the anti-IL-6 antibody may comprise anti-IL-6antibody comprises variable heavy and light chain sequences which are atleast 90% identical to the variable heavy and light sequences containedin SEQ ID NO:19 and 20.

In one embodiment, the anti-IL-6 antibody may comprise anti-IL-6antibody comprises variable heavy and light chain sequences which are atleast 95% identical to the variable heavy and light sequences containedin SEQ ID NO:19 and 20.

In one embodiment, the anti-IL-6 antibody may comprise anti-IL-6antibody comprises variable heavy and light chain sequences which are atleast 98% identical to the variable heavy and light sequences containedin SEQ ID NO:19 and 20.

In one embodiment, the anti-IL-6 antibody may comprise anti-IL-6antibody comprises the variable heavy and light sequences contained inSEQ ID NO:19 and 20.

In one embodiment, the anti-IL-6 antibody may comprise anti-IL-6antibody further comprises the constant light chain sequence containedin SEQ ID NO: 586.

In one embodiment, the anti-IL-6 antibody may comprise the constantheavy chain sequence contained in SEQ ID NO: 588.

In one embodiment, the composition may further comprise methotrexate.

In one embodiment, the composition may further comprise at least oneanti-inflammatory agent, analgesic agent, or disease-modifyingantirheumatic drug (DMARD).

In one embodiment, the anti-inflammatory agent is selected from thegroup consisting of steroids, Cortisone, Glucocorticoids, prednisone,prednisolone, Hydrocortisone (Cortisol), Cortisone acetate,Methylprednisolone, Dexamethasone, Betamethasone, Triamcinolone,Beclometasone, and Fludrocortisone acetate, non-steroidalanti-inflammatory drug (NSAIDs), ibuprofen, naproxen, meloxicam,etodolac, nabumetone, sulindac, tolementin, choline magnesiumsalicylate, diclofenac, diflusinal, indomethicin, Ketoprofen, Oxaprozin,piroxicam, and nimesulide, Salicylates, Aspirin (acetylsalicylic acid),Diflunisal, Salsalate, p-amino phenol derivatives, Paracetamol,phenacetin, Propionic acid derivatives, Ibuprofen, Naproxen, Fenoprofen,Ketoprofen, Flurbiprofen, Oxaprozin, Loxoprofen, Acetic acidderivatives, Indomethacin, Sulindac, Etodolac, Ketorolac, Diclofenac,Nabumetone, Enolic acid (Oxicam) derivatives, Piroxicam, Meloxicam,Tenoxicam, Droxicam, Lornoxicam, Isoxicam, Fenamic acid derivatives(Fenamates), Mefenamic acid, Meclofenamic acid, Flufenamic acid,Tolfenamic acid, Selective COX-2 inhibitors (Coxibs), Celecoxib,Rofecoxib, Valdecoxib, Parecoxib, Lumiracoxib, Etoricoxib, Firocoxib,Sulphonanilides, Nimesulide, and Licofelone.

In one embodiment, the analgesic agent is selected from the groupconsisting of NSAIDs, COX-2 inhibitors, Celecoxib, Rofecoxib,Valdecoxib, Parecoxib, Lumiracoxib, Etoricoxib, Firocoxib,acetaminophen, opiates, Dextropropoxyphene, Codeine, Tramadol,Anileridine, Pethidine, Hydrocodone, Morphine, Oxycodone, Methadone,Diacetylmorphine, Hydromorphone, Oxymorphone, Levorphanol,Buprenorphine, Fentanyl, Sufentanyl, Etorphine, Carfentanil,dihydromorphine, dihydrocodeine, Thebaine, Papaverine, diproqualone,Flupirtine, Tricyclic antidepressants, and lidocaine.

In one embodiment, the DMARD may be selected from the group consistingof mycophenolate mofetil (CellCept), calcineurin inhibitors,cyclosporine, sirolimus, everolimus, oral retinoids, azathioprine,fumeric acid esters, D-penicillamine, cyclophosphamide, immunoadsorptioncolumn, Prosorba® column, a gold salt, auranofin, sodium aurothiomalate(Myocrisin), hydroxychloroquine, chloroquine, leflunomide, methotrexate(MTX), minocycline, sulfasalazine (SSZ), tumor necrosis factor alpha(TNFa) blockers, etanercept (Enbrel), infliximab (Remicade), adalimumab(Humira), certolizumab pegol (Cimzia), golimumab (Simponi)), Interleukin1 (IL-1) blockers, e.g., anakinra (Kineret), monoclonal antibodiesagainst B cells, rituximab (Rituxan)), T cell costimulation blockers,abatacept (Orencia), Interleukin 6 (IL-6) blockers, tocilizumab,RoActemra, and Actemra.

In one embodiment, the DMARD is not an antibody.

In one embodiment, the administration of a composition described hereinto a patient in need thereof results in an improvement in at least oneof the following: (i) improved DAS-28 scores, (ii) improved EULARscores, (iii) improved LDAS scores (iv) improved ACR scores, (v) anincrease in serum albumin, (vi) a decrease in CRP, (vii) improvement inone or more SF-36 domain scores, (viii) an improvement in SF-6D score,wherein said efficacy is measured relative to said patient's baselineprior to administration of said antibody or antibody fragment, relativeuntreated patients, relative to patients receiving a placebo or controlformulation, or relative to age/gender norms.

In one embodiment, the administration of a composition described hereinto a patient in need thereof results in a prolonged improvement indisease (observed at least 4, 6, 8, 10, 12, 14 or 16 weeks afterantibody administration) as manifested by at least one of the following:(i) improved DAS-28 scores, (ii) improved EULAR scores, (iii) improvedLDAS scores (iv) improved ACR scores, (v) an increase in serum albumin,(vi) a decrease in CRP, (vii) improvement in one or more SF-36 domainscores, (viii) an improvement in SF-6D score, wherein said efficacy ismeasured relative to said patient's baseline prior to administration ofsaid antibody or antibody fragment, relative untreated patients,relative to patients receiving a placebo or control formulation, orrelative to age/gender norms.

In a further embodiment, the improvement in SF-6D score is at leastequal to the Minimum Important Difference (MID) relative to thepatient's SF-6D prior to said administration.

In a further embodiment, the improvement in SF-6D score is at leasttwice the MID relative to the patient's SF-6D prior to saidadministration.

In a further embodiment, the improvement in SF-6D score is at leastthree times the MID relative to the patient's SF-6D prior to saidadministration.

In another embodiment, the improvement in SF-36 may comprise animprovement in the physical functioning domain score, said improvementbeing at least equal to the minimum clinically important difference(MCID), at least 2 times the MCID, at least 3 times the MCID, at least 4times the MCID, at least 5 times the MCID, or at least 6 times the MCIDfor that domain score.

In another embodiment, the improvement in SF-36 may comprise animprovement in the role physical domain score, said improvement being atleast equal to the MCID, at least 2 times the MCID, at least 3 times theMCID, at least 4 times the MCID, at least 5 times the MCID, or at least6 times the MCID for that domain score.

In another embodiment, the improvement in SF-36 may comprise animprovement in the bodily pain domain score, said improvement being atleast equal to the MCID, at least 2 times the MCID, at least 3 times theMCID, at least 4 times the MCID, at least 5 times the MCID, or at least6 times the MCID for that domain score.

In another embodiment, the improvement in SF-36 may comprise animprovement in the general health domain score, said improvement beingat least equal to the MCID, at least 2 times the MCID, at least 3 timesthe MCID, at least 4 times the MCID, at least 5 times the MCID, or atleast 6 times the MCID for that domain score.

In another embodiment, the improvement in SF-36 may comprise animprovement in the role emotional domain score, said improvement beingat least equal to the MCID, at least 2 times the MCID, at least 3 timesthe MCID, at least 4 times the MCID, at least 5 times the MCID, or atleast 6 times the MCID for that domain score.

In another embodiment, the improvement in SF-36 may comprise animprovement in the vitality domain score, said improvement being atleast equal to the MCID, at least 2 times the MCID, at least 3 times theMCID, at least 4 times the MCID, at least 5 times the MCID, or at least6 times the MCID for that domain score.

In another embodiment, the improvement in SF-36 may comprise animprovement in the social functioning domain score, said improvementbeing at least equal to the MCID, at least 2 times the MCID, at least 3times the MCID, at least 4 times the MCID, at least 5 times the MCID, orat least 6 times the MCID for that domain score.

In another embodiment, the improvement in SF-36 may comprise animprovement in the mental health domain score, said improvement being atleast equal to the MCID, at least 2 times the MCID, at least 3 times theMCID, at least 4 times the MCID, at least 5 times the MCID, or at least6 times the MCID for that domain score.

In one embodiment, method for treating rheumatoid arthritis may compriseadministering a composition comprising at least about 10 mg/mL of ananti-IL-6 antibody having the epitopic specificity of Ab1 to a patientin need thereof.

The invention also provides for the use of an anti-IL-6 antibody havingthe epitopic specificity of Ab1 or any of the other anti-Il-6 antibodiesdisclosed herein for preparing a pharmaceutical composition for treatingrheumatoid arthritis comprising at least about 10 mg/mL of an anti-IL-6antibody having the epitopic specificity of Ab1 to a patient in needthereof.

The invention also provides for a composition for treating rheumatoidarthritis comprising at least about 10 mg/mL of an anti-IL-6 antibody toa patient in need thereof. In one embodiment, the composition maycomprises at least about 20, 30, 40, 50, 60, 70, 80, or 100 mg/mL of ananti-IL-6 antibody. In one embodiment, the composition may comprise atleast about 10-100 mg/mL of an anti-IL-6 antibody. In one embodiment,the composition may be formulated for subcutaneous administration andcomprises at least about 100 mg/mL of an anti-IL-6 antibody. In oneembodiment, the composition may be formulated for intravenousadministration and comprises at least about 10, 20, 30, or 40 mg/mL, or10-40 mg/mL of an anti-IL-6 antibody.

In one embodiment, a method of treating or preventing oral mucositiscomprising administering a composition comprises 160 mg of an Ab1antibody or antibody fragment thereof, wherein said patient does notdevelop oral mucositis more severe than a Grade 3 according to the WHOOral Mucositis Scale. In another embodiment, the patient may beundergoing chemotherapy. In another embodiment, the patient may beundergoing radiotherapy. In another embodiment, the patient has head andneck cancer. In another embodiment, the patient may not develop oralmucosits more severe than Grade 2, 1, or 0.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

FIG. 1 depicts alignments of variable light and variable heavy sequencesbetween a rabbit antibody variable light and variable heavy sequencesand homologous human sequences and the humanized sequences. Frameworkregions are identified FR1-FR4. Complementarity determining regions areidentified as CDR1-CDR3. Amino acid residues are numbered as shown. Theinitial rabbit sequences are called RbtVL and RbtVH for the variablelight and variable heavy sequences respectively. Three of the mostsimilar human germline antibody sequences, spanning from Framework 1through to the end of Framework 3, are aligned below the rabbitsequences. The human sequence that is considered the most similar to therabbit sequence is shown first. In this example those most similarsequences are L12A for the light chain and 3-64-04 for the heavy chain.Human CDR3 sequences are not shown. The closest human Framework 4sequence is aligned below the rabbit Framework 4 sequence. The verticaldashes indicate a residue where the rabbit residue is identical with atleast one of the human residues at the same position. The bold residuesindicate that the human residue at that position is identical to therabbit residue at the same position. The final humanized sequences arecalled VLh and VHh for the variable light and variable heavy sequencesrespectively. The underlined residues indicate that the residue is thesame as the rabbit residue at that position but different than the humanresidues at that position in the three aligned human sequences.

FIGS. 2 and 3 depicts alignments between a rabbit antibody light andvariable heavy sequences and homologous human sequences and thehumanized sequences. Framework regions are identified as FR1-FR4.Complementarity determining regions are identified as CDR1-CDR3.

FIGS. 4A-B and 5A-B depicts alignments between light and variable heavysequences, respectively, of different forms of Ab1. Framework regionsare identified as FR1-FR4. Complementarity determining regions areidentified as CDR1-CDR3. Sequence differences within the CDR regionshighlighted.

FIG. 6 provides the α-2-macroglobulin (A2M) dose response curve forantibody Ab1 administered intravenously at different doses one hourafter a 100 μg/kg s.c. dose of human IL-6. See also WO 2011/066371.

FIG. 7 provides survival data for the antibody Ab1 progression groupsversus control groups. See also WO 2011/066371.

FIG. 8 provides additional survival data for the antibody Ab1 regressiongroups versus control groups. See also WO 2011/066371.

FIG. 9 provides survival data for polyclonal human IgG at 10 mg/kg i.v.every three days (270-320 mg tumor size) versus antibody Ab1 at 10 mg/kgi.v. every three days (270-320 mg tumor size). See also WO 2011/066371.

FIG. 10 provides survival data for polyclonal human IgG at 10 mg/kg i.v.every three days (400-527 mg tumor size) versus antibody Ab1 at 10 mg/kgi.v. every three days (400-527 mg tumor size). See also WO 2011/066371.

FIG. 11 shows increased hemoglobin concentration followingadministration of Ab1 to patients with advanced cancer. See also WO2011/066371.

FIG. 12 depicts mean plasma lipid concentrations followingadministration of Ab1 to patients with advanced cancer. See also WO2011/066371.

FIG. 13 depicts mean neutrophil counts following administration of Ab1to patients with advanced cancer. See also WO 2011/066371.

FIG. 14A demonstrates suppression of serum CRP levels in healthyindividuals.

FIG. 14B demonstrates suppression of serum CRP levels in advanced cancerpatients.

FIG. 15A depicts the mean CRP values for each dosage concentrations(placebo, 80 mg, 160 mg, and 320 mg) of the Ab1 monoclonal antibody inNSCLC patients.

FIG. 15B depicts the change in median values of CRP from each dosageconcentration group corresponding to FIG. 15A in NSCLC patients.

FIG. 16 depicts the mean plasma CRP concentration in patients withadvanced cancer after a single I.V. infusion of 80, 160, or 320 mg ofAb1 (ALD518) (n=8).

FIG. 17 depicts the mean serum CRP levels in patients with rheumatoidarthritis patients with an inadequate response to methotrexate afterdosing at 80, 160, or 320 mg of Ab1 (ALD518).

FIG. 18A depicts that Ab1 increases mean hemoglobin concentration (g/dL)at 80, 160 and 320 mg after 12 weeks of dosing in NSCLC patients versusplacebo. See also WO 2011/066371.

FIG. 18B depicts the mean change from baseline in hemoglobinconcentration (g/dL) for NSCLC patients versus placebo. See also WO2011/066371.

FIG. 18C depicts the mean hemoglobin concentration (g/dL) in NSCLCpatients with a baseline hemoglobin below 11 g/L at baseline versus timewith Ab1 compared to placebo.

FIG. 19 depicts the mean change from baseline in hemoglobinconcentration (g/dL) for rhemumatoid arthritis patients with aninadequate response to methotrexate versus placebo. The normal range ofhemaglobin concentration is approximately 11.5-15.5 g/dL. See also WO2011/066371.

FIG. 20A depicts that Ab1 increases mean albumin concentration at 80,160 and 320 mg in NSCLC patients. See also WO 2011/066371.

FIG. 20B depicts the change from baseline for mean albumin concentrationfrom each dosage concentration group corresponding to FIG. 20A in NSCLCpatients. See also WO 2011/066371.

FIG. 20C depicts the mean albumin concentration in NSCLC patients with abaseline albumin ≦35 g/l at baseline versus time for Ab1 versus placebo.See also WO 2011/066371.

FIG. 21A depicts the mean plasma CRP levels concentration aftersubcutaneous or intravenous dosing of humanized Ab1.

FIG. 21B depicts the mean plasma CRP levels concentration aftersubcutaneous or intravenous dosing of humanized Ab1 at dosing of 50 mgor 100 mg through 12 weeks.

FIG. 22 depicts percentage of mice ulcerated at any timepoint aftersingle dose radiation.

FIG. 23 depicts median tumor volume over time.

FIG. 24 depicts the percentage of mice with no ulcerations versusulcerations on Day 10.

FIG. 25 depicts median number of days ulcerated after single dose ofradiation.

FIG. 26 depicts of patient disposition in a Phase II clinical trial foradministration of ALD518 to patients with active rheumatoid arthritis(RA). An asterisk indicates that one patient did not receive treatmentas randomized (the patient was randomized to receive 160 mg ALD518, butreceived 320 mg on Day 1 and 160 mg ALD518 at Week 8; AE=adverse event.

FIG. 27 graphically illustrates the mean changes in SF-36 compositescores at Week 12 in a Phase II clinical trial for administration ofALD518 to patients with active RA. Data are mean and error barsrepresent 95% confidence intervals (for each group, the left bar showsthe PCS score and the right bar shows the MCS score). Mean changes inPCS and MCS scores at Week 12 exceeded the MCD in all ALD-518 treatmentgroups. Greater improvements in MCS score in favor of all ALD-518treatment groups were demonstrated at Week 12 (p<0.05). MCS scoreschanges also exceeded the PCS scores in all ALD-518 treatment groups.SF-36=Short Form Health Survey-36; PCS=physical component score;MCS=mental component score; MCID=minimum clinically importantdifference.

FIG. 28A-D presents spydergrams summarizing the changes from baseline toweek 12 in SF-36 domain scores compared with age/gender matched normsfor a Phase II clinical trial for administration of ALD518 to patientswith active RA. The spydergrams summarize age/gender norms, averagebaseline scores prior to treatment, and average scores after treatmentin each of eight tested domains for patients receiving 80 mg (panel A),160 mg (panel B), or 320 mg (panel C) ALD-518, or placebo (panel D).PF=physical function; RP=role physical; BP=bodily pain; GH=generalhealth; VT=vitality; SF=social functioning; RE=role emotional; MH=mentalhealth; SF-36=Short Form-36.

FIG. 29A-B presents spydergrams summarizing the changes from baseline toweeks 12 (A) and 16 (B) in SF-36 domain scores compared with age/gendermatched norms for a Phase II clinical trial for administration of ALD518to patients with active RA. The spydergrams summarize scores in eighttested domains for age/gender norms, combined average baseline scoresprior to treatment, and average scores after treatment for eachtreatment group (ALD-518 dosages of 80 mg, 160 mg, or 320 mg), and theplacebo group. Abbreviations are as in FIG. 28.

FIG. 30 depicts WHO oral mucositis grade versus cumulative IMRT (Gy):ALD518 160 mg intravenous at week 0 and week 4 for three patients.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS Definitions

It is to be understood that this invention is not limited to theparticular methodology, protocols, cell lines, animal species or genera,and reagents described, as such may vary. It is also to be understoodthat the terminology used herein is for the purpose of describingparticular embodiments only, and is not intended to limit the scope ofthe present invention which will be limited only by the appended claims.

As used herein the singular forms “a”, “and”, and “the” include pluralreferents unless the context clearly dictates otherwise. Thus, forexample, reference to “a cell” includes a plurality of such cells andreference to “the protein” includes reference to one or more proteinsand equivalents thereof known to those skilled in the art, and so forth.All technical and scientific terms used herein have the same meaning ascommonly understood to one of ordinary skill in the art to which thisinvention belongs unless clearly indicated otherwise.

Amplification as used herein, refers broadly to the amplification ofpolynucleotide sequences is the in vitro production of multiple copiesof a particular nucleic acid sequence. The amplified sequence is usuallyin the form of DNA. A variety of techniques for carrying out suchamplification are known in the art. See, e.g., Van Brunt (1990)Bio/Technol. 8(4): 291-294. Polymerase chain reaction or PCR is aprototype of nucleic acid amplification, and use of PCR herein should beconsidered exemplary of other suitable amplification techniques.

Antibody, as used herein, refers broadly to any polypeptidechain-containing molecular structure with a specific shape that fits toand recognizes an epitope, where at least one non-covalent bindinginteractions stabilize the complex between the molecular structure andthe epitope. The archetypal antibody molecule is the immunoglobulin, andall types of immunoglobulins, IgG, IgM, IgA, IgE, IgD, from all sources,e.g., human, rodent, rabbit, cow, sheep, pig, dog, chicken, areconsidered to be “antibodies.” Antibodies include but are not limited tochimeric antibodies, human antibodies and other non-human mammalianantibodies, humanized antibodies, single chain antibodies (scFvs),camelbodies, nanobodies, IgNAR (single-chain antibodies derived fromsharks), small-modular immunopharmaceuticals (SMIPs), and antibodyfragments (e.g., Fabs, Fab′, F(ab′)₂.) Numerous antibody codingsequences have been described; and others may be raised by methodswell-known in the art. See Streltsov, et al. (2005) Protein Sci. 14(11):2901-9; Greenberg, et al. (1995) Nature 374(6518): 168-173; Nuttall, etal. (2001) Mol Immunol. 38(4): 313-26; Hamers-Casterman, et al. (1993)Nature 363(6428): 446-8; Gill, et al. (2006) Curr Opin Biotechnol.17(6): 653-8.

Antibody fragment, as used herein, refers broadly to a fragment of anantibody which recognizes an antigen (e.g., paratopes, antigen-bindingfragment.) The antibody fragment may comprise a paratope that may be asmall region (e.g., 15-22 amino acids) of the antibody's Fv region andmay contain parts of the antibody's heavy and light chains. See Goldsby,et al. Antigens (Chapter 3) Immunology (5^(th) Ed.) New York: W.H.Freeman and Company, pages 57-75.

C-Reactive Protein (CRP), as used herein, refers broadly to a 224 aminoacid protein found in the blood that rise in response to inflammation[(e.g., GenBank Protein Accession No. NP_(—)000558 (SEQ ID NO: 726)].CRP also encompasses any pre-pro, pro- and mature forms of this CRPamino acid sequence, as well as mutants and variants including allelicvariants of this sequence. CRP levels, e.g. in the serum, liver, orelsewhere in the body, can be readily measured using routine methods andcommercially available reagents, e.g. ELISA, antibody test strip,immunoturbidimetry, rapid immunodiffusion, visual agglutination, Westernblot, Northern blot As mentioned above CRP levels may in addition bemeasured in patients having or at risk of developing thrombosisaccording to the invention.

Coding sequence, as used herein refers broadly to an in-frame sequenceof codons that (in view of the genetic code) correspond to or encode aprotein or peptide sequence. Two coding sequences correspond to eachother if the sequences or their complementary sequences encode the sameamino acid sequences. A coding sequence in association with appropriateregulatory sequences may be transcribed and translated into apolypeptide. A polyadenylation signal and transcription terminationsequence will usually be located 3′ to the coding sequence. A “promotersequence” is a DNA regulatory region capable of binding RNA polymerasein a cell and initiating transcription of a downstream (3′ direction)coding sequence. Promoter sequences typically contain additional sitesfor binding of regulatory molecules (e.g., transcription factors) whichaffect the transcription of the coding sequence. A coding sequence is“under the control” of the promoter sequence or “operatively linked” tothe promoter when RNA polymerase binds the promoter sequence in a celland transcribes the coding sequence into mRNA, which is then in turntranslated into the protein encoded by the coding sequence. Apolynucleotide sequence “corresponds” to a polypeptide sequence iftranslation of the polynucleotide sequence in accordance with thegenetic code yields the polypeptide sequence (i.e., the polynucleotidesequence “encodes” the polypeptide sequence), one polynucleotidesequence “corresponds” to another polynucleotide sequence if the twosequences encode the same polypeptide sequence.

Complementarity determining region, hypervariable region, or CDR, asused herein refer broadly to at least one of the hyper-variable orcomplementarity determining regions (CDRs) found in the variable regionsof light or heavy chains of an antibody (See Kabat, E. A. et al. (1987)Sequences of Proteins of Immunological Interest, National Institutes ofHealth, Bethesda, Md.). These expressions include the hypervariableregions as defined by Kabat et al. (“Sequences of Proteins ofImmunological Interest,” Kabat E., et al. (1983) US Dept. of Health andHuman Services) or the hypervariable loops in 3-dimensional structuresof antibodies. Chothia and Lesk (1987) J. Mol. Biol. 196: 901-917. TheCDRs in each chain are held in close proximity by framework regions and,with the CDRs from the other chain, contribute to the formation of theantigen binding site. Within the CDRs there are select amino acids thathave been described as the selectivity determining regions (SDRs) whichrepresent the critical contact residues used by the CDR in theantibody-antigen interaction (Kashmiri (2005) Methods 36:25-34). CDRsfor exemplary anti-IL-6 antibodies are provided herein.

Disease or condition, as used herein, refers broadly to a disease orcondition that a patient has been diagnosed with or is suspected ofhaving, particularly a disease or condition associated with elevatedIL-6. A disease or condition encompasses, without limitation thereto,mucositis, as well as idiopathic conditions characterized by symptomsthat include elevated IL-6.

Effective amount, as used herein, refers broadly to an amount of anactive ingredient that is effective to relieve or reduce to some extentat least one of the symptoms of the disease in need of treatment, or toretard initiation of clinical markers or symptoms of a disease in needof prevention, when the compound is administered. Thus, an effectiveamount refers to an amount of the active ingredient which exhibiteffects such as (i) reversing the rate of progress of a disease; (ii)inhibiting to some extent further progress of the disease; and/or, (iii)relieving to some extent (or, preferably, eliminating) at least onesymptoms associated with the disease. The effective amount may beempirically determined by experimenting with the compounds concerned inknown in vivo and in vitro model systems for a disease in need oftreatment. The context in which the phrase “effective amount” is usedmay indicate a particular desired effect. For example, “an amount of ananti-IL-6 antibody effective to prevent or treat a hypercoagulablestate” and similar phrases refer to an amount of anti-IL-6 antibodythat, when administered to a subject, will cause a measurableimprovement in the subject's coagulation profile, or prevent, slow,delay, or arrest, a worsening of the coagulation profile for which thesubject is at risk. Similarly, “an amount of an anti-IL-6 antibodyeffective to reduce serum CRP levels” and similar phrases refer to anamount of anti-IL-6 antibody that, when administered to a subject, willcause a measurable decrease in serum CRP levels, or prevent, slow,delay, or arrest, an increase in serum CRP levels for which the subjectis at risk. Similarly, “an amount of an anti-IL-6 antibody effective toincrease serum albumin levels” and similar phrases refer to an amount ofanti-IL-6 antibody that, when administered to a subject, will cause ameasurable increase in serum albumin levels, or prevent, slow, delay, orarrest, a decrease in serum albumin levels for which the subject is atrisk. Similarly, “an amount of an anti-IL-6 antibody effective to reduceweakness” and similar phrases refer to an amount of anti-IL-6 antibodythat, when administered to a subject, will cause a measurable decreasein weakness as determined by the hand grip strength test. Similarly, “anamount of an anti-IL-6 antibody effective to increase weight” andsimilar phrases refer to an amount of anti-IL-6 antibody that, whenadministered to a subject, will cause a measurable increase in apatient's weight. An effective amount will vary according to the weight,sex, age and medical history of the individual, as well as the severityof the patient's condition(s), the type of disease(s), mode ofadministration, and the like. An effective amount may be readilydetermined using routine experimentation, e.g., by titration(administration of increasing dosages until an effective dosage isfound) and/or by reference to amounts that were effective for priorpatients. Generally, the anti-IL-6 antibodies of the present inventionwill be administered in dosages ranging between about 0.1 mg/kg andabout 20 mg/kg of the patient's body-weight.

Expression Vector, as used herein, refers broadly to a DNA vectorscontain elements that facilitate manipulation for the expression of aforeign protein within the target host cell. Conveniently, manipulationof sequences and production of DNA for transformation is first performedin a bacterial host (e.g., E. coli) and usually vectors will includesequences to facilitate such manipulations, including a bacterial originof replication and appropriate bacterial selection marker. Selectionmarkers encode proteins necessary for the survival or growth oftransformed host cells grown in a selective culture medium. Host cellsnot transformed with the vector containing the selection gene will notsurvive in the culture medium. Typical selection genes encode proteinsthat (a) confer resistance to antibiotics or other toxins, (b)complement auxotrophic deficiencies, or (c) supply critical nutrientsnot available from complex media. Exemplary vectors and methods fortransformation of yeast are described, for example, in Burke, Dawson, &Stearns (2000) Methods in Yeast Genetics: a Cold Spring HarborLaboratory course manual. Cold Spring Harbor Laboratory Press.

Folding, as used herein, refers broadly to the three-dimensionalstructure of polypeptides and proteins, where interactions between aminoacid residues act to stabilize the structure. While non-covalentinteractions are important in determining structure, usually theproteins of interest will have intra- and/or intermolecular covalentdisulfide bonds formed by two cysteine residues. For naturally occurringproteins and polypeptides or derivatives and variants thereof, theproper folding is typically the arrangement that results in optimalbiological activity, and can conveniently be monitored by assays foractivity, e.g. ligand binding, enzymatic activity.

Framework region or FR, as used herein refers broadly to at least one ofthe framework regions within the variable regions of the light and heavychains of an antibody. See Kabat, et al. (1987) Sequences of Proteins ofImmunological Interest, National Institutes of Health, Bethesda, Md.These expressions include those amino acid sequence regions interposedbetween the CDRs within the variable regions of the light and heavychains of an antibody. As mentioned in the preferred embodiments, theFRs may comprise human FRs highly homologous to the parent antibody(e.g., rabbit antibody).

Glasgow Prognostic Score (GPS), as used herein, refers broadly to aninflammation-based prognostic score that awards one point for a serumalbumin level less than <35 mg/L and one point for a CRP level above 10mg/L. Thus, a GPS of 0 indicates normal albumin and CRP, a GPS of 1indicates reduced albumin or elevated CRP, and a GPS of 2 indicates bothreduced albumin and elevated CRP.

gp130 (also called Interleukin-6 receptor subunit beta), as used herein,refers broadly to a transmembrane protein that forms one subunit of typeI cytokine receptors in the IL-6 receptor family [(e.g., 918 precursoramino acid sequence available as Swiss-Prot Protein Accession No. P40189(SEQ ID NO: 728)]. gp130 also encompasses any pre-pro, pro- and matureforms of this amino acid sequence, such as the mature form encoded byamino acids 23 through 918 of the sequence shown, as well as mutants andvariants including allelic variants of this sequence.

Heterologous region or domain of a DNA construct, as used herein, refersbroadly to an identifiable segment of DNA within a larger DNA moleculethat is not found in association with the larger molecule in nature.Thus, when the heterologous region encodes a mammalian gene, the genewill usually be flanked by DNA that does not flank the mammalian genomicDNA in the genome of the source organism. Another example of aheterologous region is a construct where the coding sequence itself isnot found in nature (e.g., a cDNA where the genomic coding sequencecontains introns, or synthetic sequences having codons different thanthe native gene). Allelic variations or naturally-occurring mutationalevents do not give rise to a heterologous region of DNA as definedherein.

Homology, as used herein, refers broadly to a degree of similaritybetween a nucleic acid sequence and a reference nucleic acid sequence orbetween a polypeptide sequence and a reference polypeptide sequence.Homology may be partial or complete. Complete homology indicates thatthe nucleic acid or amino acid sequences are identical. A partiallyhomologous nucleic acid or amino acid sequence is one that is notidentical to the reference nucleic acid or amino acid sequence. Thedegree of homology can be determined by sequence comparison. The term“sequence identity” may be used interchangeably with “homology.”

Host cell, as used herein, refers broadly to a cell that contains anexpression vector and supports the replication or expression of theexpression vector. Host cells may be prokaryotic cells such as E. coli,or eukaryotic cells such as yeast, insect (e.g., SF9), amphibian, ormammalian cells such as CHO, HeLa, HEK-293 (e.g., cultured cells,explants, and cells in vivo.)

Isolated, as used herein, refers broadly to material removed from itsoriginal environment in which it naturally occurs, and thus is alteredby the hand of man from its natural environment. Isolated material maybe, for example, exogenous nucleic acid included in a vector system,exogenous nucleic acid contained within a host cell, or any materialwhich has been removed from its original environment and thus altered bythe hand of man (e.g., “isolated antibody”).

Improved, as used herein, refers broadly to any beneficial changeresulting from a treatment. A beneficial change is any way in which apatient's condition is better than it would have been in the absence ofthe treatment. “Improved” includes prevention of an undesired condition,slowing the rate at which a condition worsens, delaying the developmentof an undesired condition, and restoration to an essentially normalcondition. For example, improvement in mucositis encompasses anydecrease in pain, swelling, joint stiffness, or inflammation, and/or anincrease in joint mobility.

IL-6 antagonist, as used herein, refers broadly to any composition thatprevents, inhibits, or lessens the effect(s) of IL-6 signaling.Generally, such antagonists may reduce the levels or activity of IL-6,IL-6 receptor alpha, gp130, or a molecule involved in IL-6 signaltransduction, or may reduce the levels or activity complexes between theforegoing (e.g., reducing the activity of an IL-6/IL-6 receptorcomplex). Antagonists include antisense nucleic acids, including DNA,RNA, or a nucleic acid analogue such as a peptide nucleic acid, lockednucleic acid, morpholino (phosphorodiamidate morpholino oligo), glycerolnucleic acid, or threose nucleic acid. See Heasman (2002) Dev Biol.243(2): 209-14; Hannon and Rossi (2004) Nature 431(7006):371-8; Paul, etal. (2002) Nat Biotechnol. 20(5):505-8; Zhang, et al. (2005) J Am ChemSoc. 127(12):4174-5; Wahlestedt, et al. (2000) Proc Natl Acad Sci USA.97(10):5633-8; Hanvey, et al. (1992) Science 258 (5087):1481-5; Braasch,et al. (2002) Biochemistry 41(14): 4503-10; Schoning, et al. (2000)Science 290(5495): 1347-51. In addition IL-6 antagonists specificallyinclude peptides that block IL-6 signaling such as those described inany of U.S. Pat. Nos. 5,210,075; 6,172,042; 6,599,875; 6,841,533; and6,838,433. Also, IL-6 antagonists according to the invention may includep38 MAP kinase inhibitors such as those reported in U.S. PatentApplication No. 2007/0010529 given this kinase's role in cytokineproduction and more particularly IL-6 production. Further, IL-6antagonists according to the invention include the glycoalkaloidcompounds reported in U.S. Patent Application Publication No.2005/0090453 as well as other IL-6 antagonist compounds isolatable usingthe IL-6 antagonist screening assays reported therein. Other IL-6antagonists include antibodies, such as anti-IL-6 antibodies, anti-IL-6receptor alpha antibodies, anti-gp130 antibodies, and anti-p38 MAPkinase antibodies including (but not limited to) the anti-IL-6antibodies disclosed herein, Actemra® (Tocilizumab), Remicade®, Zenapax®(daclizumab), or any combination thereof. Other IL-6 antagonists includeportions or fragments of molecules involved in IL-6 signaling, such asIL-6, IL-6 receptor alpha, and gp130, which may be native, mutant, orvariant sequence, and may optionally be coupled to other moieties (suchas half-life-increasing moieties, e.g. an Fc domain). For example, anIL-6 antagonist may be a soluble IL-6 receptor or fragment, a solubleIL-6 receptor:Fc fusion protein, a small molecule inhibitor of IL-6, ananti-IL-6 receptor antibody or antibody fragment or variant thereof,antisense nucleic acid. Other IL-6 antagonists include avemirs, such asC326 (Silverman, et al. (2005) Nat Biotechnol. 23(12): 1556-61) andsmall molecules, such as synthetic retinoid AM80 (tamibarotene) (Takeda,et al. (2006) Arterioscler Thromb Vasc Biol. 26(5): 1177-83). Such IL-6antagonists may be administered by any means known in the art, includingcontacting a subject with nucleic acids which encode or cause to beexpressed any of the foregoing polypeptides or antisense sequences.

Interleukin-6 (IL-6), as used herein, refers broadly to interleukin-6(IL-6) encompasses not only the following 212 amino acid sequenceavailable as GenBank Protein Accession No. NP_(—)000591 (e.g., SEQ IDNO: 1), but also any pre-pro, pro- and mature forms of this IL-6 aminoacid sequence, as well as mutants and variants including allelicvariants of this sequence.

Interleukin-6 receptor (IL-6R) (IL-6 receptor alpha (IL-6RA) [CD126], asused herein, refers broadly to 468 amino acid protein that binds IL-6, apotent pleiotropic cytokine that regulates cell growth anddifferentiation and also plays an important role in immune response(e.g., Swiss-Prot Protein Accession No. P08887 and SEQ ID NO: 727).IL-6R also includes any pre-pro, pro- and mature forms of this aminoacid sequence, as well as mutants and variants including allelicvariants of this sequence.

Mammal, as used herein, refers broadly to any and all warm-bloodedvertebrate animals of the class Mammalia, including humans,characterized by a covering of hair on the skin and, in the female,milk-producing mammary glands for nourishing the young. Examples ofmammals include but are not limited to alpacas, armadillos, capybaras,cats, camels, chimpanzees, chinchillas, cattle, dogs, goats, gorillas,hamsters, horses, humans, lemurs, llamas, mice, non-human primates,pigs, rats, sheep, shrews, squirrels, and tapirs. Mammals include butare not limited to bovine, canine, equine, feline, murine, ovine,porcine, primate, and rodent species. Mammal also includes any and allthose listed on the Mammal Species of the World maintained by theNational Museum of Natural History, Smithsonian Institution inWashington D.C.

Meiosis, as used herein, refers broadly to a process by which a diploidyeast cell undergoes reductive division to form four haploid sporeproducts. Each spore may then germinate and form a haploid vegetativelygrowing cell line.

Nucleic acid or nucleic acid sequence, as used herein, refers broadly toa deoxy-ribonucleotide or ribonucleotide oligonucleotide in eithersingle- or double-stranded form. The term encompasses nucleic acids,i.e., oligonucleotides, containing known analogs of natural nucleotides.The term also encompasses nucleic-acid-like structures with syntheticbackbones. Unless otherwise indicated, a particular nucleic acidsequence also implicitly encompasses conservatively modified variantsthereof (e.g., degenerate codon substitutions) and complementarysequences, as well as the sequence explicitly indicated. The termnucleic acid is used interchangeably with gene, cDNA, mRNA,oligonucleotide, and polynucleotide.

Operatively linked, as used herein, refers broadly to when two DNAfragments are joined such that the amino acid sequences encoded by thetwo DNA fragments remain in-frame.

Paratope, as used herein, refers broadly to the part of an antibodywhich recognizes an antigen (e.g., the antigen-binding site of anantibody.) Paratopes may be a small region (e.g., 15-22 amino acids) ofthe antibody's Fv region and may contain parts of the antibody's heavyand light chains. See Goldsby, et al. Antigens (Chapter 3) Immunology(5^(th) Ed.) New York: W.H. Freeman and Company, pages 57-75.

Patient, as used herein, refers broadly to any animal who is in need oftreatment either to alleviate a disease state or to prevent theoccurrence or reoccurrence of a disease state. Also, “Patient” as usedherein, refers broadly to any animal who has risk factors, a history ofdisease, susceptibility, symptoms, signs, was previously diagnosed, isat risk for, or is a member of a patient population for a disease. Thepatient may be a clinical patient such as a human or a veterinarypatient such as a companion, domesticated, livestock, exotic, or zooanimal. The term “subject” may be used interchangeably with the term“patient”.

Polyploid yeast that stably expresses or expresses a desired secretedheterologous polypeptide for prolonged time, as used herein, refersbroadly to a yeast culture that secretes said polypeptide for at leastseveral days to a week, more preferably at least a month, still morepreferably at least about 1-6 months, and even more preferably for morethan a year at threshold expression levels, typically at least about10-25 mg/liter and preferably substantially greater.

Polyploidal yeast culture that secretes desired amounts of recombinantpolypeptide, as used herein, refers broadly to cultures that stably orfor prolonged periods secrete at least about 10-25 mg/liter ofheterologous polypeptide, more preferably at least about 50-500mg/liter, and most preferably at least about 500-1000 mg/liter or more.

Prolonged reduction in serum CRP, and similar phrases, as used hereinrefer broadly to a measurable decrease in serum CRP level relative tothe initial serum CRP level (i.e. the serum CRP level at a time beforetreatment begins) that is detectable within about a week from when atreatment begins (e.g. administration of an anti-IL-6 antibody) andremains below the initial serum CRP level for an prolonged duration,e.g. at least about 14 days, at least about 21 days, at least about 28days, at least about 35 days, at least about 40 days, at least about 50days, at least about 60 days, at least about 70 days, at least about 11weeks, or at least about 12 weeks from when the treatment begins.

Promoter, as used herein, refers broadly to an array of nucleic acidsequences that direct transcription of a nucleic acid. As used herein, apromoter includes necessary nucleic acid sequences near the start siteof transcription, such as, in the case of a polymerase II type promoter,a TATA element. A promoter also optionally includes distal enhancer orrepressor elements, which can be located as much as several thousandbase pairs from the start site of transcription. A “constitutive”promoter is a promoter that is active under most environmental anddevelopmental conditions. An “inducible” promoter is a promoter that isactive under environmental or developmental regulation.

Prophylactically effective amount, as used herein, refers broadly to theamount of a compound that, when administered to a patient forprophylaxis of a disease or prevention of the reoccurrence of a disease,is sufficient to effect such prophylaxis for the disease orreoccurrence. The prophylactically effective amount may be an amounteffective to prevent the incidence of signs and/or symptoms. The“prophylactically effective amount” may vary depending on the diseaseand its severity and the age, weight, medical history, predisposition toconditions, preexisting conditions, of the patient to be treated.

Prophylaxis, as used herein, refers broadly to a course of therapy wheresigns and/or symptoms are not present in the patient, are in remission,or were previously present in a patient. Prophylaxis includes preventingdisease occurring subsequent to treatment of a disease in a patient.Further, prevention includes treating patients who may potentiallydevelop the disease, especially patients who are susceptible to thedisease (e.g., members of a patent population, those with risk factors,or at risk for developing the disease).

Recombinant as used herein, refers broadly with reference to a product,e.g., to a cell, or nucleic acid, protein, or vector, indicates that thecell, nucleic acid, protein or vector, has been modified by theintroduction of a heterologous nucleic acid or protein or the alterationof a native nucleic acid or protein, or that the cell is derived from acell so modified. Thus, for example, recombinant cells express genesthat are not found within the native (non-recombinant) form of the cellor express native genes that are otherwise abnormally expressed, underexpressed or not expressed at all.

Selectable Marker, as used herein, refers broadly to a selectable markeris a gene or gene fragment that confers a growth phenotype (physicalgrowth characteristic) on a cell receiving that gene as, for examplethrough a transformation event. The selectable marker allows that cellto survive and grow in a selective growth medium under conditions inwhich cells that do not receive that selectable marker gene cannot grow.Selectable marker genes generally fall into several types, includingpositive selectable marker genes such as a gene that confers on a cellresistance to an antibiotic or other drug, temperature when two tsmutants are crossed or a ts mutant is transformed; negative selectablemarker genes such as a biosynthetic gene that confers on a cell theability to grow in a medium without a specific nutrient needed by allcells that do not have that biosynthetic gene, or a mutagenizedbiosynthetic gene that confers on a cell inability to grow by cells thatdo not have the wild type gene; and the like. Suitable markers includebut are not limited to ZEOMYCIN® (zeocin), neomycin, G418, LYS3, MET1,MET3a, ADE1, ADE3, and URA3.

Specifically (or selectively) binds to an antibody or “specifically (orselectively) immunoreactive with,” or “specifically interacts or binds,”as used herein, refers broadly to a protein or peptide (or otherepitope), refers, in some embodiments, to a binding reaction that isdeterminative of the presence of the protein in a heterogeneouspopulation of proteins and other biologics. For example, underdesignated immunoassay conditions, the specified antibodies bind to aparticular protein at least two times greater than the background(non-specific signal) and do not substantially bind in a significantamount to other proteins present in the sample. Typically a specific orselective reaction will be at least twice background signal or noise andmore typically more than about 10 to 100 times background.

Signs of disease, as used herein, refers broadly to any abnormalityindicative of disease, discoverable on examination of the patient; anobjective indication of disease, in contrast to a symptom, which is asubjective indication of disease.

Solid support, support, and substrate, as used herein, refers broadly toany material that provides a solid or semi-solid structure with whichanother material can be attached including but not limited to smoothsupports (e.g., metal, glass, plastic, silicon, and ceramic surfaces) aswell as textured and porous materials.

Subjects as used herein, refers broadly to anyone suitable to be treatedaccording to the present invention include, but are not limited to,avian and mammalian subjects, and are preferably mammalian. Mammals ofthe present invention include, but are not limited to, canines, felines,bovines, caprines, equines, ovines, porcines, rodents (e.g., rats andmice), lagomorphs, primates, humans. Any mammalian subject in need ofbeing treated according to the present invention is suitable. Humansubjects of both genders and at any stage of development (i.e., neonate,infant, juvenile, adolescent, adult) can be treated according to thepresent invention. The present invention may also be carried out onanimal subjects, particularly mammalian subjects such as mice, rats,dogs, cats, cattle, goats, sheep, and horses for veterinary purposes,and for drug screening and drug development purposes. “Subjects” is usedinterchangeably with “patients.”

Mating competent yeast species, as used herein refers broadly encompassany diploid or tetraploid yeast which can be grown in culture. Suchspecies of yeast may exist in a haploid, diploid, or tetraploid form.The cells of a given ploidy may, under appropriate conditions,proliferate for indefinite number of generations in that form. Diploidcells can also sporulate to form haploid cells. Sequential mating canresult in tetraploid strains through further mating or fusion of diploidstrains. In the present invention the diploid or polyploidal yeast cellsare preferably produced by mating or spheroplast fusion.

Haploid Yeast Cell, as used herein, refers broadly to a cell having asingle copy of each gene of its normal genomic (chromosomal) complement.

Polyploid Yeast Cell, as used herein, refers broadly to a cell havingmore than one copy of its normal genomic (chromosomal) complement.

Diploid Yeast Cell, as used herein, refers broadly to a cell having twocopies (alleles) of essentially every gene of its normal genomiccomplement, typically formed by the process of fusion (mating) of twohaploid cells.

Tetraploid Yeast Cell, as used herein, refers broadly to a cell havingfour copies (alleles) of essentially every gene of its normal genomiccomplement, typically formed by the process of fusion (mating) of twohaploid cells. Tetraploids may carry two, three, four, or more differentexpression cassettes. Such tetraploids might be obtained in S.cerevisiae by selective mating homozygotic heterothallic a/a andalpha/alpha diploids and in Pichia by sequential mating of haploids toobtain auxotrophic diploids. For example, a [met his] haploid can bemated with [ade his] haploid to obtain diploid [his]; and a [met arg]haploid can be mated with [ade arg] haploid to obtain diploid [arg];then the diploid [his]×diploid [arg] to obtain a tetraploid prototroph.It will be understood by those of skill in the art that reference to thebenefits and uses of diploid cells may also apply to tetraploid cells.

Yeast Mating, as used herein, refers broadly to a process by which twohaploid yeast cells naturally fuse to form one diploid yeast cell.

Variable region or VR as used herein refers broadly to the domainswithin each pair of light and heavy chains in an antibody that areinvolved directly in binding the antibody to the antigen. Each heavychain has at one end a variable domain (V_(H)) followed by a number ofconstant domains. Each light chain has a variable domain (V_(L)) at oneend and a constant domain at its other end; the constant domain of thelight chain is aligned with the first constant domain of the heavychain, and the light chain variable domain is aligned with the variabledomain of the heavy chain.

Variants, as used herein refers broadly to single-chain antibodies,dimers, multimers, sequence variants, and domain substitution variants.Single-chain antibodies such as SMIPs, shark antibodies, nanobodies(e.g., Camelidiae antibodies). Sequence variants can be specified bypercentage identity (similarity, sequence homology) e.g., 99%, 95%, 90%,85%, 80%, 70%, 60%, or by numbers of permitted conservative ornon-conservative substitutions. Domain substitution variants includereplacement of a domain of one protein with a similar domain of arelated protein. A similar domain may be identified by similarity ofsequence, structure (actual or predicted), or function. For example,domain substitution variants include the substitution of at least oneCDRs and/or framework regions.

The techniques and procedures are generally performed according toconventional methods well known in the art and as described in variousgeneral and more specific references that are cited and discussedthroughout the present specification. See, e.g., Sambrook, et al. (2001)Molec. Cloning: Lab. Manual [3^(rd) Ed] Cold Spring Harbor LaboratoryPress. Standard techniques may be used for recombinant DNA,oligonucleotide synthesis, and tissue culture, and transformation (e.g.,electroporation, lipofection). Enzymatic reactions and purificationtechniques may be performed according to manufacturer's specificationsor as commonly accomplished in the art or as described herein. Thenomenclatures utilized in connection with, and the laboratory proceduresand techniques of, analytical chemistry, synthetic organic chemistry,and medicinal and pharmaceutical chemistry described herein are thosewell known and commonly used in the art. Standard techniques may be usedfor chemical syntheses, chemical analyses, pharmaceutical preparation,formulation, and delivery, and treatment of patients.

Mucositis

Mucositis is a medical term that is used to refer to mouth sores, oralmucositis, or esophagitis. It can range in severity from a red, soremouth and/or gums to open sores that can cause a patient to be unable toeat. The lining of the entire gastrointestinal tract (e.g., mouth,throat, stomach, and bowel) is made up of epithelial cells, which divideand replicate rapidly, and are killed by chemotherapy and radiationtherapy. Thus the entire lining of the entire gastrointestinal tractfrom the mouth to the anus are susceptible to mucositis (e.g.,alimentary tract mucositis). Mucositis can occur in areas of thealimentary tract; for example, gastrointestinal (GI) mucositis. Emesis(vomiting) and diarrhea are also common in mucositis, especiallygastrointestinal mucositis. See Lalla, et al. (2008) Dent Clin North Am.52(1): 61-viii.

Patients treated with radiation therapy for head and neck cancertypically receive an approximately 200 cGy daily dose of radiation, fivedays per week, for 5-7 continuous weeks. Almost all such patients willdevelop some degree of oral mucositis. In recent studies, severe oralmucositis occurred in 29-66% of all patients receiving radiation therapyfor head and neck cancer. The incidence of oral mucositis was especiallyhigh in (A) patients with primary tumors in the oral cavity, oropharynxor nasopharynx, (B) those who also received concomitant chemotherapy,(C) those who received a total dose over 5000 cGy, and (D) those whowere treated with altered fractionation radiation schedules (e.g., morethan one radiation treatment per day). See Lalla, et al. (2008) DentClin North Am. 52(1): 61-viii.

Recent studies have indicated that the fundamental mechanisms involvedin the pathogenesis of mucositis are much more complex than directdamage to epithelium alone. Mechanisms for radiation-induced andchemotherapy-induced mucositis are believed to be similar. The followingfive-stage model for the pathogenesis of mucositis:

-   1. Initiation of tissue injury: Radiation and/or chemotherapy induce    cellular damage resulting in death of the basal epithelial cells.    The generation of reactive oxygen species (free radicals) by    radiation or chemotherapy is also believed to exert a role in the    initiation of mucosal injury. These small highly reactive molecules    are byproducts of oxygen metabolism and can cause significant    cellular damage.-   2. Upregulation of inflammation via generation of messenger signals:    In addition to causing direct cell death, free radicals activate    second messengers that transmit signals from receptors on the    cellular surface to the inside of the cell. This leads to    upregulation of pro-inflammatory cytokines, tissue injury and cell    death.-   3. Signaling and amplification: Upregulation of proinflammatory    cytokines such as tumor necrosis factor-alpha (TNF-α), produced    mainly by macrophages, causes injury to mucosal cells, and also    activates molecular pathways that amplify mucosal injury.-   4. Ulceration and inflammation: There is a significant inflammatory    cell infiltrate associated with the mucosal ulcerations, based in    part on metabolic byproducts of the colonizing oral microflora.    Production of pro-inflammatory cytokines is also further upregulated    due to this secondary infection.-   5. Healing: This phase is characterized by epithelial proliferation    as well as cellular and tissue differentiation, restoring the    integrity of the epithelium.

The degree and extent of oral mucositis that develops in any particularpatient and site appears to depend on factors such as age, gender,underlying systemic disease and race as well as tissue specific factors(e.g., epithelial types, local microbial environment and function). SeeLalla, et al. (2008) Dent Clin North Am. 52(1): 61-viii.

The IL-6 antagonists described herein, include but are not limited toanti-IL-6 antibodies and antibody fragments, and may be used in methodsand compositions for the treatment of mucositis (e.g., oral, esophageal,alimentary, gastrointestinal tract mucositis).

Oral Mucositis

Oral mucositis is a significant problem in patients undergoingchemotherapeutic management for solid tumors. In one study, it wasreported that 303 of 599 patients (51%) receiving chemotherapy for solidtumors or lymphoma developed oral and/or GI mucositis. Oral mucositisdeveloped in 22% of 1236 cycles of chemotherapy, GI mucositis in 7% ofcycles and both oral and GI mucositis in 8% of cycles. An even higherpercentage (approximately 75-80%) of patients who receive high-dosechemotherapy prior to hematopoietic cell transplantation developclinically significant oral mucositis. See Lalla, et al. (2008) DentClin North Am. 52(1): 61-viii.

Oral mucositis leads to several problems, including pain, nutritionalproblems as a result of inability to eat, and increased risk ofinfection due to open sores in the mucosa. Oral mucositis has asignificant effect on the patient's quality of life and can bedose-limiting (requiring a reduction in subsequent chemotherapy doses).

Signs and symptoms of mucositis include: red, shiny, or swollen mouthand gums; blood in the mouth; sores in the mouth or on the gums ortongue; soreness or pain in the mouth or throat; difficulty swallowingor talking; feeling of dryness, mild burning, or pain when eating food;soft, whitish patches or pus in the mouth or on the tongue; andIncreased mucus or thicker saliva in the mouth.

Over forty percent of patients who receive chemotherapy will developsome degree of mucositis during the course of their treatment. Patientsreceiving radiation to the head, neck, or chest areas, and patients whoundergo bone marrow or stem cell transplant, are even more likely todevelop mucositis. Certain chemotherapy agents are more likely to causethis side effect (Table 1), as is total body irradiation which is oftenused for bone marrow transplants.

TABLE 1 Select chemotherapy agents known to cause mucositis. Alemtuzumab(Campath ®) Bleomycin (Blenoxane ®) Asparaginase (Elspar ®)Cyclophosphamide (Cytoxan ®) Cytarabine (Cytosar-U ®) Busulfan(Myleran ®, Busulfex ®) Docetaxel (Taxotere ®) Doxorubicin(Adriamycin ®) Capecitabine (Xeloda ®) Fluorouracil (5-FU ®) Gemcitabine(Gemzar ®) Carboplatin (Paraplatin ®) Gemtuzumab ozogamicin (Mylotarg ®)Hydroxyurea (Hydrea ®) Daunorubicin (Cerubidine ®) Idarubicin(Idamycin ®) Interleukin 2 (Proleukin ®) Epirubicin (Ellence ®)Lomustine (CeeNU ®) Melphalan (Alkeran ®) Etoposide (VePesid ®)Mitomycin (Mutamycin ®) Mitoxantrone (Novantrone ®) Irinotecan(Camptosar ®) Oxaliplatin (Eloxatin ®) Paclitaxel (Taxol ®) Methotrexate(Rheumatrex ®) Pentostatin (Nipent ®) Procarbazine (Matulane ®)Mechlorethamine (Mustargen ®) Topotecan (Hycamtin ®) Trastuzumab(Herceptin ®) Pemetrexed (Alimta ®) Vinblastine (Velban ®) Vincristine(Oncovin ®) Thiotepa (Thioplex ®) Tretinoin (Vesanoid ®) Cisplatin(PLATINOL ®)

Poor oral or dental health, smoking, using chewing tobacco, drinkingalcohol, dehydration, and diseases such as kidney disease, diabetes orHIV/AIDS can increase the likelihood of developing mucositis or worsenit.

Monitoring the development and resolution of mucositis can be difficult,given that the experience is different for every patient. The WorldHealth Organization (WHO) oral toxicity scale is a commonly used gradingsystems developed to assist in evaluating the severity of mucositis:

TABLE 2 Oral Mucositis Severity Scale (adapted from WHO ORAL TOXICITYSCALE) Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 None Soreness & Erythema,Ulcers, Mucositis to erythema ulcers; extensive the extent Patient canerythema; that alimentation swallow Patients cannot is not possiblesolid diet swallow solid diet

Numerous studies using many different medications and interventions havebeen tried to reduce the incidence and severity of oral mucositis.Unfortunately, only a few of these interventions have shown muchsuccess. Currently, good oral care regimen (Table 3) is the mosteffective in preventing or decreasing the severity of mucositis and helpprevent the development of infection through open mouth sores. Themainstay of an oral care regimen is mouth rinses, and numerous studieshave determined old salt water is an effective mouth rinse. The mouthrinse aides in removing debris and keeping the oral tissue moist andclean. Other important components include using mouth and lipmoisturizers, using a soft-bristle toothbrush, maintaining adequateintake of fluids and protein, and avoiding irritating foods, alcohol andtobacco.

TABLE 3 Example of oral care protocol Oral Care Protocol RecommendationsNormal saline (1 tsp of table salt to 1 quart (32 oz.) of water) [e.g.,salt and soda (one-half tsp of salt and 2 tbsp of sodium bicarbonate in1 quart of warm water)] Use a soft-bristle toothbrush after meals and atbedtime. If the brush causes pain, toothettes may be used Use anon-abrasive toothpaste (or mix 1 tsp baking soda in 2 cups water).Avoid toothpastes with whiteners. Keep lips moist with moisturizers.Avoid using Vaseline (the oil base can promote infection). Avoidproducts that irritate the mouth and gums: avoid commercial mouthwashesand those with alcohol Limit use of dental floss, DO NOT use withplatelets below 40,000 Do not use lemon or glycerin swabs ortoothbrushes without soft bristles Increase your fluid intake. Try toinclude foods high in protein in your diet. Avoid hot, spicy or acidicfoods, alcohol, hard or coarse foods (crusty bread, chips, crackers). Ifyou wear dentures: remove whenever possible to expose gums to air Loosefitting dentures can irritate the mouth and gums and should not be wornDo not wear dentures if mouth sores are severe Do not smoke cigarettes,cigars or pipes. Do not use smokeless tobacco (chewing tobacco, snuff)

Cryotherapy, which involves sucking on ice chips during chemotherapyadministration, has shown some effect in alleviating mucositis caused by5-FU (fluorouracil). Two agents, Gelclair® and Zilactin®, are mucosalprotectants that work by coating the mucosa, forming a protectivebarrier for exposed nerve endings. These agents resulted in improvedpain control, and ability to eat and speak. Amifostine (Ethyol®), a drugthat protects against the damage to the mucosa caused by radiation(approved by the FDA for patients receiving radiation therapy forcancers of the head and neck).

Keratinocyte growth factor (KGF) stimulates the growth, repair, andsurvival of cells that protect the lining of the mouth and GI tract.Recombinant human KGF has been developed as the drug KEPIVANCE®(palifermin) and is currently used for treating oral mucositis inpatients with hematologic malignancies receiving myelotoxic therapyrequiring hematopoietic stem cell support (HSCT). Palifermin was foundto decrease the length and severity of oral mucositis in these patients.“Coping with Cancer” by Vachani of the Abramson Cancer Center of theUniversity of Pennsylvania (2009). The IL-6 antagonists, includinganti-IL-6 antibodies and antibody fragments thereof, may be used inmethods and compositions for the treatment of mucositis, including oralmucositis associated with chemotherapy and radiotherapy. Emesis anddiarrhea may also be seen in patients suffering from oral mucositis. TheIL-6 antagonists, including anti-IL-6 antibodies may be used in methodsand compositions for the treatment of emesis and diarrhea associatedwith chemotherapy, radiotherapy, and oral mucositis.

Alimentary Tract Mucositis

Mucositis is a major acute clinical problem in oncology, caused by thecytotoxic effects of chemotherapy and radiotherapy. The condition mayaffect the mucosa of the entire alimentary tract (AT), causing mouth andthroat pain, ulceration, abdominal pain, bloating, vomiting (emesis),and diarrhea. Mucositis is extremely common, occurring in approximately40% of patients following standard doses of chemotherapy and in almostall patients undergoing high-dose chemotherapy with stem-celltransplantation or head-and-neck radiation. Bowen, et al. (2011) Journalof Supportive Oncology 9(5): 161-168.

Alimentary tract mucositis refers to the expression of mucosal injuryacross the continuum of oral and gastrointestinal mucosa, from the mouthto the anus. Incidence of WHO grade 3 or 4 oral mucositis can be as highas ˜75% in patients undergoing hematopoietic stem-cell transplantation(HSCT), depending on the intensity of the conditioning regimen used andthe use of methotrexate. For all tumor sites, chemotherapy with5-fluorouracil (5-FU), capecitabine or tegafur leads to a high rate(e.g. 20-50%) of alimentary tract mucositis. Chemotherapy withmethotrexate and other antimetabolites leads to a 20-60% rate ofalimentary tract mucositis according to the drug's given dose per cycle.See Peterson, et al. (2009) Annals of Oncology 20(Supplement 4):iv174-iv177 and Logan, et al. (2008) Cancer chemotherapy andPharmacology 62(1): 33-41. The IL-6 antagonists, including anti-IL-6antibodies and antibody fragments thereof, may be used in methods andcompositions for the treatment of alimentary tract mucositis, includingalimentary tract mucositis associated with chemotherapy andradiotherapy. Emesis and diarrhea are also commonly seen in patientssuffering from mucositis, especially alimentary tract mucositis. TheIL-6 antagonists, including anti-IL-6 antibodies may be used in methodsand compositions for the treatment of emesis and diarrhea associatedwith chemotherapy, radiotherapy, and alimentary tract mucositis.

Gastrointestinal Tract Mucositis

Gastrointestinal mucositis may result from chemotherapy and/orradiotherapy and refers to inflammatory lesions in the gastrointestinaltract. Vomiting (emesis), and diarrhea are common elements ofgastrointestinal mucositis.

Basic bowel care including maintenance of adequate hydration isrecommended for patients undergoing chemotherapy and radiotherapy tolimit the effects of gastrointestinal mucositis. Current recommendationsalso include administration of 500 mg sulfasalazine orally twice dailyto reduce the incidence and severity of radiation-induced enteropathy inpatients receiving external beam radiotherapy to the pelvis. Amifostineis also suggested in a dose of at least 340 mg/m² to prevent radiationproctitis in those receiving standard-dose radiotherapy for rectalcancer. Additionally, octreotide at a dose of at least 100 μg s.c. twicedaily when loperamide fails to control diarrhea induced by standard-doseor high-dose chemotherapy associated with HSCT as well as amifostine issuggested to reduce esophagitis induced by concomitant chemotherapy andradiotherapy in patients with non-small-cell lung cancer. See Peterson,et al. (2009) Annals of Oncology 20(Supplement 4): iv174-iv177. The IL-6antagonists, including anti-IL-6 antibodies and antibody fragmentsthereof, may be used in methods and compositions for the treatment ofgastrointestinal mucositis, including gastrointestinal mucositisassociated with chemotherapy and radiotherapy.

Emesis and diarrhea are also commonly seen in patients suffering frommucositis, especially gastrointestinal tract mucositis. See Lalla, etal. (2008) Dent Clin North Am. 51(1): 61-viii. The IL-6 antagonists,including anti-IL-6 antibodies may be used in methods and compositionsfor the treatment of emesis and diarrhea associated with chemotherapy,radiotherapy, and gastrointestinal tract mucositis.

Treatment of Rheumatoid Arthritis

This invention also relates to the use of IL-6 antagonists includinganti-IL-6 antibodies described herein, such as Ab1 or humanized formsthereof for treating or preventing rheumatoid arthritis. Thisapplication provides results of clinical studies showing safety,pharmacokinetics, and pharmacodynamics for subcutaneous and intravenousadministration of an exemplary anti-IL-6 antibody, Ab1 (also known asALD-518, exemplary sequences are provided in Table 4.) The clinical datademonstrates that an anti-IL-6 antibody decreases disease severity inrheumatoid arthritis patients which have been subcutaneously (SC) orintravenously (IV) administered ALD-518, including improvement in mentaland physical components of disease.

The anti-IL-6 antibody (e.g., ALD518) was well tolerated whenadministered in a single subcutaneous (SC) dose; injection sitereactions were generally mild. The bioavailability of SC ALD518 was ˜60%of IV ALD518, and the half life was ˜30 days. Rapid and significantreductions in CRP (C-reactive protein) were observed, which weresustained over 24 weeks of assessment. The half-life of ALD518 whenadministered subcutaneously (approximately 30 days) is similar to thehalf-life previously observed with IV administration. Additionally,subcutaneous ALD518 led to rapid and large reductions in serum CRP andthe reductions in CRP observed during the first 12 weeks of the studywere sustained over 24 weeks of assessment. These results are alsosimilar to those observed with N administration. Together, these resultssuggest that anti-IL-6 antibodies, such as Ab1 (ALD518) may be used forthe treatment of RA, as well as prevention or treatment of other IL-6associated conditions. These therapeutic regimens may be combined withother RA therapeutics, including methotrexate or other RA drugsidentified herein and generally known in the art, including analgesics,disease-modifying antirheumatic drugs (DMARDS), anti-inflammatories, andothers.

The invention further provides specific dosage regimens and dosageformulations for treating rheumatoid arthritis by subcutaneous orintravenous administration of anti-IL-6 antibodies or antibody fragmentsaccording to the invention such as humanized Ab1 antibodies. Forexample, a subject may be administered 80, 160, or 320 mg of ananti-IL-6 antibody (e.g., Ab1).

The anti-IL-6 antibodies may be used to subcutaneously administerantibodies of the invention, including Ab1, for rheumatoid arthritisindications, the administration formulation comprises, or alternativelyconsists of, about 50 or 100 mg/mL of antibody, about 5 mM Histidinebase, about 5 mM Histidine HCl to make final pH 6, 250 mM sorbitol, and0.015% (w/w) Polysorbate 80. In another embodiment of the invention thatmay be used to subcutaneously administer antibodies of the invention,including Ab1, for rheumatoid arthritis indications, the administrationformulation comprises, or alternatively consists of, about 20 or 100mg/mL of antibody, about 5 mM Histidine base, about 5 mM Histidine HClto make final pH 6, 250 to 280 mM sorbitol (or sorbitol in combinationwith sucrose), and 0.015% (w/w) Polysorbate 80, said formulation havinga nitrogen headspace in the shipping vials.

Therapeutic regimens for the prevention or treatment of RA may becombined with other RA therapeutics, including analgesics, analgesics,DMARDS, anti-inflammatories, and others. For example, analgesics andanti-inflammatory drugs, including steroids, may provide relief ofdisease symptoms, while disease-modifying antirheumatic drugs (DMARDs),may inhibit or halt the underlying immune process and prevent furtherlong-term damage. In exemplary embodiments, ALD518 (or another antibodyof the present disclosure) may be administered to a patient atapproximately the same time as another RA therapeutic (which may or maynot be formulated together) or may be administered to a patient who isalso undergoing another therapeutic regiment but not necessarily at thesame time. A regimen may be considered to provide a combination oftherapeutics as long as the patient concurrently experiences the effectsof the combined therapeutics. Due to possible differences in dosingschedule, a combination may include administration of differenttherapeutics at different times, e.g., a patient may receive a drug suchas methotrexate on a weekly schedule (e.g., at least 10 mg per week) andmay receive ALD518 (or another anti-IL-6 antibody of the presentdisclosure) less frequently (such as about every eight weeks, everytwelve weeks, every three months). Exemplary DMARDs that mayadministered in combination with ALD518 (or another antibody of thepresent disclosure) include, but are not limited to Mycophenolatemofetil (CellCept®), calcineurin inhibitors (e.g., cyclosporine,sirolimus, everolimus), oral retinoids, azathioprine, fumeric acidesters, D-penicillamine, cyclophosphamide, immunoadsorption columns(e.g., Prosorba® columns), gold salts (e.g., Auranofin, sodiumaurothiomalate (Myocrisin)), hydroxychloroquine, chloroquine,leflunomide, methotrexate (MTX), minocycline, sulfasalazine (SSZ), tumornecrosis factor alpha (TNFα) blockers (e.g., etanercept (Enbrel),infliximab (Remicade), adalimumab (Humira), certolizumab pegol (Cimzia),golimumab (Simponi)), Interleukin 1 (IL-1) blockers (e.g., anakinra(Kineret)), monoclonal antibodies against B cells (e.g., rituximab(Rituxan)), T cell costimulation blockers (e.g., abatacept (Orencia)),Interleukin 6 (IL-6) blockers (e.g., tocilizumab (an anti-IL-6 receptorantibody), RoActemra, Actemra). Exemplary anti-inflammatory agents thatmay administered in combination with ALD518 (or another antibody of thepresent disclosure) include, but are not limited to, anti-inflammatorysteroids such as Cortisone, Glucocorticoids, prednisone, prednisolone,Hydrocortisone (Cortisol), Cortisone acetate, Methylprednisolone,Dexamethasone, Betamethasone, Triamcinolone, Beclometasone, andFludrocortisone acetate, and non-steroidal anti-inflammatory drug(NSAIDs) (which may also act as analgesics), such as ibuprofen,naproxen, meloxicam, etodolac, nabumetone, sulindac, tolementin, cholinemagnesium salicylate, diclofenac, diflusinal, indomethicin, Ketoprofen,Oxaprozin, piroxicam, and nimesulide, Salicylates, Aspirin(acetylsalicylic acid), Diflunisal, Salsalate, p-amino phenolderivatives, Paracetamol, phenacetin, Propionic acid derivatives,Ibuprofen, Naproxen, Fenoprofen, Ketoprofen, Flurbiprofen, Oxaprozin,Loxoprofen, Acetic acid derivatives, Indomethacin, Sulindac, Etodolac,Ketorolac, Diclofenac, Nabumetone, Enolic acid (Oxicam) derivatives,Piroxicam, Meloxicam, Tenoxicam, Droxicam, Lornoxicam, Isoxicam, Fenamicacid derivatives (Fenamates), Mefenamic acid, Meclofenamic acid,Flufenamic acid, Tolfenamic acid, Selective COX-2 inhibitors (Coxibs),Celecoxib, Rofecoxib, Valdecoxib, Parecoxib, Lumiracoxib, Etoricoxib,Firocoxib, Sulphonanilides, Nimesulide, and Licofelone. Exemplaryanalgesics include that may administered in combination with ALD518 (oranother antibody of the present disclosure) include, but are not limitedto, NSAIDs, COX-2 inhibitors (including Celecoxib, Rofecoxib,Valdecoxib, Parecoxib, Lumiracoxib, Etoricoxib, and Firocoxib),acetaminophen, opiates (e.g., Dextropropoxyphene, Codeine, Tramadol,Anileridine, Pethidine, Hydrocodone, Morphine [e.g., oral, intravenous(IV), or intramuscular (IM)], Oxycodone, Methadone, Diacetylmorphine,Hydromorphone, Oxymorphone, Levorphanol, Buprenorphine, Fentanyl,Sufentanyl, Etorphine, Carfentanil, dihydromorphine, dihydrocodeine,Thebaine, and Papaverine), diproqualone, Flupirtine, Tricyclicantidepressants, and lidocaine (topical).

Anti-IL-6 Antagonists

The IL-6 antagonist may comprise an antibody, an antibody fragment, apeptide, a glycoalkoid, an antisense nucleic acid, a ribozyme, aretinoid, an avemir, a small molecule, or any combination thereof. TheIL-6 antagonist may be an agent that blocks signal transmission by IL-6,blocks IL-6 binding to its receptor, suppresses/interferes with IL-6expression, and/or inhibits the biological activity of IL-6. The IL-6antagonists may be attached directly or indirectly to immunoglobulinpolypeptides or effector moieties such as therapeutic or detectableentities.

Examples of IL-6 antagonists include but are not limited to anti-IL-6antibody, anti-IL-6R antibody, anti-gp130 antibody, IL-6 mutant, IL-6Rantisense oligonucleotide, and partial peptides of IL-6 or IL-6R. Anexample of the IL-6 mutant used in the present invention is disclosed inBrakenhoff, et al. (1994) J. Biol. Chem. 269: 86-93 or Savino, et al.(1994) EMBO J. 13: 1357-1367. The IL-6 mutant polypeptide or fragmentthereof does not possess the signal transmission effects of IL-6 butretains the binding activity with IL-6R, and is produced by introducinga mutation in the form of a substitution, deletion or insertion into theamino acid sequence of IL6. While there are no limitations on the animalspecies used, it is preferable to use an IL6 of human origin. Similarly,any IL-6 partial peptides or IL-6R partial peptides used in the presentinvention provided they prevent IL6 or IL6R (gp80) or gp130 fromaffecting signal transduction and thereby prevent IL-6 associatedbiological activity. For details regarding IL-6 partial peptides andIL-6R partial peptides, see, e.g., U.S. Pat. No. 5,210,075 and EP PatentNo. 617126. Additionally, a mutated soluble IL-6 receptor may be used asan IL-6 antagonist. See Salvati, et al. (1995) The Journal of BiologicalChemistry 270: 12242-12249.

IL-6 signaling is mediated by the Jak-Tyk family of cytoplasmic tyrosinekinases, including JAK1, JAK2, and JAK3 (reviewed in Murray (2007) JImmunol. 178(5): 2623-9). Inhibitors of JAK1, JAK2, or JAK3 may be usedas IL-6 antagonists of IL-6. Sivash, et al. (2004) British Journal ofCancer 91: 1074-1080. An inhibitor of Syk may be used as an IL-6antagonist. Ulanova, et al. (2005) Am J Physiol Lung Cell Mol Physiol.288(3): L497-507. Thalidomide, and derivatives thereof, such aslenalidomide, may be useful antagonists of IL-6. Kedar, et al. (2004)Int J Cancer. 110(2): 260-5.

Further, oligonucleotides capable of IL6 or IL6R RNA silencing orantisense mechanisms can be used in the method of the present invention(JP5-300338 for details regarding IL-6R antisense oligonucleotide).

Additionally, the IL-6 antagonist may target IL-6, IL-6 receptor α,gp130, p38 MAP kinase, JAK1, JAK2, JAK3, SYK, or any combinationthereof. For example, SANT-7 is an IL-6 receptor antagonist thatinterferes with the formation of IL-6/IL-6R/gp130 heteromers. SeeHönemann, et al. (2001) Int. J. Cancer 93: 674-680.

The IL-6 antagonist may comprise an anti-IL-6 receptor (e.g.,TOCILIZUMAB®, ACTEMRA®), anti-IL6 (e.g., SILTUXIMAB®), anti-gp130,anti-p38 MAP kinase, anti-JAK1, anti-JAK2, anti-JAK3, or anti-SYKantibody or antibody fragment. See Nishimoto, et al. (2005) Blood106(8): 2627-32; van Rhee, et al. (2010) Journal of Clinical Oncology28(23): 3701-3708; WO 2010/056948; U.S. Patent Application PublicationNo. 2010/0138945.

The IL-6 antagonist may comprise a small molecule including but notlimited to thalidomide, lenalidomide, aryl hodrocarbon receptor agonists(e.g., 7,12-dimethylbenz[a]anthracene (DMBA) and2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)) or any combination thereof.See Jensen, et al. (2003) Environmental Health: A Global Access ScienceSource 2:16.

IL-6 antagonist may be an IL-6 antagonist peptide. See, e.g., U.S. Pat.No. 6,838,433. For example, a truncated IL-6 molecule may act as an IL-6antagonist. See Alberti, et al. (2005) J. Cancer Res 65: 2-5.

The IL-6 antagonist may be an anti-IL-6 antibody. See also U.S. PatentApplication Publication No. 2007/0292420. The IL-6 antagonist maycomprise an anti-IL-6 antibody or antibody fragment as described infurther detail herein. The invention includes antibodies having bindingspecificity to IL-6 and possessing a variable light chain sequencecomprising the sequence set forth in the polypeptide sequence of SEQ IDNO: 2 or SEQ ID NO: 709 and humanized versions and variants thereofincluding those set forth in FIGS. 1-5, and those identified in Table 4.

Anti-IL-6 Antibodies and Antibody Fragments Thereof

Antibodies consist of two identical light polypeptide chains ofmolecular weight approximately 23,000 daltons (the “light chain”), andtwo identical heavy chains of molecular weight 53,000-70,000 (the “heavychain”). The four chains are joined by disulfide bonds in a “Y”configuration wherein the light chains bracket the heavy chains startingat the mouth of the “Y” configuration. The “branch” portion of the “Y”configuration is designated the Fab region; the stem portion of the “Y”configuration is designated the Fc region. The amino acid sequenceorientation runs from the N-terminal end at the top of the “Y”configuration to the C-terminal end at the bottom of each chain. TheN-terminal end possesses the variable region having specificity for theantigen that elicited it, and is approximately 100 amino acids inlength, there being slight variations between light and heavy chain andfrom antibody to antibody.

The variable region is linked in each chain to a constant region thatextends the remaining length of the chain and that within a particularclass of antibody does not vary with the specificity of the antibody(i.e., the antigen eliciting it). There are five known major classes ofconstant regions that determine the class of the immunoglobulin molecule(IgG, IgM, IgA, IgD, and IgE corresponding to γ, μ, α, δ, and ε (gamma,mu, alpha, delta, or epsilon) heavy chain constant regions). Theconstant region or class determines subsequent effector function of theantibody, including activation of complement (Kabat, E. A. (1976)Structural Concepts in Immunology and Immunochemistry [2^(nd) Ed.] pages413-436, Holt, Rinehart, Winston), and other cellular responses(Andrews, et al. (1980) Clinical Immunobiology pages 1-18, W. B.Sanders; Kohl, et al. (1983) Immunology 48: 187); while the variableregion determines the antigen with which it will react. Light chains areclassified as either κ (kappa) or λ (lambda). Each heavy chain class canbe paired with either kappa or lambda light chain. The light and heavychains are covalently bonded to each other, and the “tail” portions ofthe two heavy chains are bonded to each other by covalent disulfidelinkages when the immunoglobulins are generated either by hybridomas orby B cells.

For example, antibodies or antigen binding fragments or variants thereofmay be produced by genetic engineering. In this technique, as with othermethods, antibody-producing cells are sensitized to the desired antigenor immunogen. The messenger RNA isolated from antibody producing cellsis used as a template to make cDNA using PCR amplification. A library ofvectors, each containing one heavy chain gene and one light chain generetaining the initial antigen specificity, is produced by insertion ofappropriate sections of the amplified immunoglobulin cDNA into theexpression vectors. A combinatorial library is constructed by combiningthe heavy chain gene library with the light chain gene library. Thisresults in a library of clones which co-express a heavy and light chain(resembling the Fab fragment or antigen binding fragment of an antibodymolecule). The vectors that carry these genes are co-transfected into ahost cell. When antibody gene synthesis is induced in the transfectedhost, the heavy and light chain proteins self-assemble to produce activeantibodies that can be detected by screening with the antigen orimmunogen.

Antibody coding sequences of interest include those encoded by nativesequences, as well as nucleic acids that, by virtue of the degeneracy ofthe genetic code, are not identical in sequence to the disclosed nucleicacids, and variants thereof. Variant polypeptides can include amino acid(aa) substitutions, additions or deletions. The amino acid substitutionscan be conservative amino acid substitutions or substitutions toeliminate non-essential amino acids, such as to alter a glycosylationsite, or to minimize misfolding by substitution or deletion of at leastone cysteine residues that are not necessary for function. Variants canbe designed so as to retain or have enhanced biological activity of aparticular region of the protein (e.g., a functional domain, catalyticamino acid residues). Variants also include fragments of thepolypeptides disclosed herein, particularly biologically activefragments and/or fragments corresponding to functional domains.Techniques for in vitro mutagenesis of cloned genes are known. Alsoincluded in the subject invention are polypeptides that have beenmodified using ordinary molecular biological techniques so as to improvetheir resistance to proteolytic degradation or to optimize solubilityproperties or to render them more suitable as a therapeutic agent.

Chimeric antibodies may be made by recombinant means by combining thevariable light and heavy chain regions (V_(L) and V_(H)), obtained fromantibody producing cells of one species with the constant light andheavy chain regions from another. Typically chimeric antibodies utilizerodent or rabbit variable regions and human constant regions, in orderto produce an antibody with predominantly human domains. The productionof such chimeric antibodies is well known in the art, and may beachieved by standard means (as described, e.g., in U.S. Pat. No.5,624,659, incorporated herein by reference in its entirety). It isfurther contemplated that the human constant regions of chimericantibodies of the invention may be selected from IgG1, IgG2, IgG3, IgG4,IgG5, IgG6, IgG7, IgG8, IgG9, IgG10, IgG11, IgG12, IgG13, IgG14, IgG15,IgG16, IgG17, IgG18 or IgG19 constant regions.

Humanized antibodies are engineered to contain even more human-likeimmunoglobulin domains, and incorporate only thecomplementarity-determining regions of the animal-derived antibody. Thisis accomplished by carefully examining the sequence of thehyper-variable loops of the variable regions of the monoclonal antibody,and fitting them to the structure of the human antibody chains. Althoughfacially complex, the process is straightforward in practice. See, e.g.,U.S. Pat. No. 6,187,287. In a preferred embodiment, humanization may beeffected as disclosed in detail infra. This scheme grafts CDRs ontohuman FRs highly homologous to the parent antibody that is beinghumanized.

Immunoglobulins and fragments thereof may be modifiedpost-translationally, e.g. to add effector moieties such as chemicallinkers, detectable moieties, such as fluorescent dyes, enzymes, toxins,substrates, bioluminescent materials, radioactive materials,chemiluminescent moieties and the like, or specific binding moieties,such as streptavidin, avidin, or biotin, and the like may be utilized inthe methods and compositions of the present invention.

Exemplary Anti-IL-6 Antibodies

The invention also includes antibodies having binding specificity toIL-6 and possessing a variable heavy chain sequence comprising thesequence set forth in the polypeptide sequences of SEQ ID NO: 3 and SEQID NO: 657 and humanized versions and variants thereof including thoseset forth in FIGS. 1-5, and those identified in Table 4.

The invention further includes antibodies having binding specificity toIL-6 and possessing a variable heavy chain sequence which is a modifiedversion of SEQ ID NO: 3 wherein the tryptophan residue in CDR2 ischanged to a serine as set forth in the polypeptide sequence of SEQ IDNO: 658 and humanized versions and variants thereof including those setforth in FIGS. 1-5, and those identified in Table 4.

The invention further contemplates antibodies comprising at least one ofthe polypeptide sequences of SEQ ID NO: 4; SEQ ID NO: 5; and SEQ ID NO:6 which correspond to the complementarity-determining regions (CDRs, orhypervariable regions) of the variable light chain sequence of SEQ IDNO: 2, and/or at least one of the polypeptide sequences of SEQ ID NO: 7;SEQ ID NO: 8 or 120; and SEQ ID NO: 9 which correspond to thecomplementarity-determining regions (CDRs, or hypervariable regions) ofthe variable heavy chain sequence of SEQ ID NO: 3 or 19, or combinationsof these polypeptide sequences. In another embodiment of the invention,the antibodies of the invention include combinations of the CDRs and thevariable heavy and light chain sequences set forth herein.

In another embodiment, the invention contemplates other antibodies, suchas for example chimeric antibodies, comprising at least one of thepolypeptide sequences of SEQ ID NO: 4; SEQ ID NO: 5; and SEQ ID NO: 6which correspond to the complementarity-determining regions (CDRs, orhypervariable regions) of the variable light chain sequence of SEQ IDNO: 2, and/or at least one of the polypeptide sequences of SEQ ID NO: 7;SEQ ID NO: 8 or 120; and SEQ ID NO: 9 which correspond to thecomplementarity-determining regions (CDRs, or hypervariable regions) ofthe variable heavy chain sequence of SEQ ID NO: 3 or 19, or combinationsof these polypeptide sequences. In another embodiment of the invention,the antibodies of the invention include combinations of the CDRs andhumanized versions of the variable heavy and light chain sequences setforth above.

The invention also contemplates fragments of the antibody having bindingspecificity to IL-6. In one embodiment of the invention, antibodyfragments of the invention comprise, or alternatively consist of,humanized versions of the polypeptide sequence of SEQ ID NO: 2, 20, 647,651, 660, 666, 699, 702, 706, or 709. In another embodiment of theinvention, antibody fragments of the invention comprise, oralternatively consist of, humanized versions of the polypeptide sequenceof SEQ ID NO: 3, 18, 19, 652, 656, 657, 658, 661, 664, 665, 704, or 708.

In a further embodiment of the invention, fragments of the antibodyhaving binding specificity to IL-6 comprise, or alternatively consistof, at least one of the polypeptide sequences of SEQ ID NO: 4; SEQ IDNO: 5; and SEQ ID NO: 6 which correspond to thecomplementarity-determining regions (CDRs, or hypervariable regions) ofthe variable light chain sequence of SEQ ID NO: 2 or SEQ ID NO: 709.

In a further embodiment of the invention, fragments of the antibodyhaving binding specificity to IL-6 comprise, or alternatively consistof, at least one of the polypeptide sequences of SEQ ID NO: 7; SEQ IDNO: 8 or SEQ ID NO: 120; and SEQ ID NO: 9 which correspond to thecomplementarity-determining regions (CDRs, or hypervariable regions) ofthe variable heavy chain sequence of SEQ ID NO: 3 and 657 or 19.

The invention also contemplates antibody fragments which include atleast one of the antibody fragments described herein. In one embodimentof the invention, fragments of the antibodies having binding specificityto IL-6 comprise, or alternatively consist of, one, two, three or more,including all of the following antibody fragments: the variable lightchain region of SEQ ID NO: 2; the variable heavy chain region of SEQ IDNO: 3; the complementarity-determining regions (SEQ ID NO: 4; SEQ ID NO:5; and SEQ ID NO: 6) of the variable light chain region of SEQ ID NO: 2;and the complementarity-determining regions (SEQ ID NO: 7; SEQ ID NO: 8or SEQ ID NO: 120; and SEQ ID NO: 9) of the variable heavy chain regionof SEQ ID NO: 3 and 657 or 19.

The invention also contemplates variants wherein either of the heavychain polypeptide sequences of SEQ ID NO: 18 or SEQ ID NO: 19 issubstituted for the heavy chain polypeptide sequence of SEQ ID NO: 3 or657; the light chain polypeptide sequence of SEQ ID NO: 20 issubstituted for the light chain polypeptide sequence of SEQ ID NO: 2 orSEQ ID NO: 709; and the heavy chain CDR sequence of SEQ ID NO: 120 issubstituted for the heavy chain CDR sequence of SEQ ID NO: 8.

In a preferred embodiment of the invention, the anti-IL-6 antibody isAb1, comprising SEQ ID NO: 2 and SEQ ID NO: 3, or more particularly anantibody comprising SEQ ID NO: 657 and SEQ ID NO: 709 (which arerespectively encoded by the nucleic acid sequences in SEQ ID NO: 700 andSEQ ID NO: 723) or one comprised of the alternative SEQ ID NOs set forthin the preceding paragraph, and having at least one of the biologicalactivities set forth herein. In a preferred embodiment the anti-IL-6antibody will comprise a humanized sequence as shown in FIGS. 1-5.

Sequences of anti-IL-6 antibodies of the present invention are shown inTable 4. Exemplary sequence variants other alternative forms of theheavy and light chains of Ab1 through Ab36 are shown. The antibodies ofthe present invention encompass additional sequence variants, includingconservative substitutions, substitution of at least one CDR sequencesand/or FR sequences.

Exemplary Ab1 embodiments include an antibody comprising a variant ofthe light chain and/or heavy chain. Exemplary variants of the lightchain of Ab1 include the sequence of any of the Ab1 light chains shown(i.e., any of SEQ ID NO: 2, 20, 647, 651, 660, 666, 699, 702, 706, or709) wherein the entire CDR1 sequence is replaced or wherein at leastone residues in the CDR1 sequence is substituted by the residue in thecorresponding position of any of the other light chain CDR1 sequencesset forth (i.e., any of SEQ ID NO: 23, 39, 55, 71, 87, 103, 124, 140,156, 172, 188, 204, 220, 236, 252, 268, 284, 300, 316, 332, 348, 364,380, 396, 412, 428, 444, 460, 476, 492, 508, 524, 540, 556, or 572);and/or wherein the entire CDR2 sequence is replaced or wherein at leastone residues in the CDR2 sequence is substituted by the residue in thecorresponding position of any of the other light chain CDR2 sequencesset forth (i.e., any of SEQ ID NO: 24, 40, 56, 72, 88, 104, 125, 141,157, 173, 189, 205, 221, 237, 253, 269, 285, 301, 317, 333, 349, 365,381, 397, 413, 429, 445, 461, 477, 493, 509, 525, 541, 557, or 573);and/or wherein the entire CDR3 sequence is replaced or wherein at leastone residues in the CDR3 sequence is substituted by the residue in thecorresponding position of any of the other light chain CDR3 sequencesset forth (i.e., any of SEQ ID NO: 25, 41, 57, 73, 89, 105, 126, 142,158, 174, 190, 206, 222, 238, 254, 270, 286, 302, 318, 334, 350, 366,382, 398, 414, 430, 446, 462, 478, 494, 510, 526, 542, 558, or 574).

Exemplary variants of the heavy chain of Ab1 include the sequence of anyof the Ab1 heavy chains shown (i.e., any of SEQ ID NO: 3, 18, 19, 652,656, 657, 658, 661, 664, 665, 704, or 708) wherein the entire CDR1sequence is replaced or wherein at least one residues in the CDR1sequence is substituted by the residue in the corresponding position ofany of the other heavy chain CDR1 sequences set forth (i.e., any of SEQID NO: 26, 42, 58, 74, 90, 106, 127, 143, 159, 175, 191, 207, 223, 239,255, 271, 287, 303, 319, 335, 351, 367, 383, 399, 415, 431, 447, 463,479, 495, 511, 527, 543, 559, or 575); and/or wherein the entire CDR2sequence is replaced or wherein at least one residues in the CDR2sequence is substituted by the residue in the corresponding position ofan Ab1 heavy chain CDR2, such as those set forth in Table 4 (i.e., anyof SEQ ID NO: 8, or 120) or any of the other heavy chain CDR2 sequencesset forth (i.e., any of SEQ ID NO: 27, 43, 59, 75, 91, 107, 121, 128,144, 160, 176, 192, 208, 224, 240, 256, 272, 288, 304, 320, 336, 352,368, 384, 400, 416, 432, 448, 464, 480, 496, 512, 528, 544, 560, or576); and/or wherein the entire CDR3 sequence is replaced or wherein atleast one residues in the CDR3 sequence is substituted by the residue inthe corresponding position of any of the other heavy chain CDR3sequences set forth (i.e., any of SEQ ID NO: 28, 44, 60, 76, 92, 108,129, 145, 161, 177, 193, 209, 225, 241, 257, 273, 289, 305, 321, 337,353, 369, 385, 401, 417, 433, 449, 465, 481, 497, 513, 529, 545, 561, or577).

In another embodiment, the invention contemplates other antibodies, suchas for example chimeric or humanized antibodies, comprising at least oneof the polypeptide sequences of SEQ ID NO: 4; SEQ ID NO: 5; and SEQ IDNO: 6 which correspond to the complementarity-determining regions (CDRs,or hypervariable regions) of the variable light chain sequence of SEQ IDNO: 2, and/or at least one of the polypeptide sequences of SEQ ID NO: 7(CDR1); SEQ ID NO: 8 (CDR2); SEQ ID NO: 120 (CDR2); and SEQ ID NO: 9(CDR3) which correspond to the complementarity-determining regions(CDRs, or hypervariable regions) of the variable heavy chain sequence ofSEQ ID NO: 3 or SEQ ID NO: 19, or combinations of these polypeptidesequences. In another embodiment of the invention, the antibodies of theinvention include combinations of the CDRs and the variable heavy andlight chain sequences set forth above including those set forth in FIGS.1-5, and those identified in Table 4.

In another embodiment the anti-IL-6 antibody of the invention is onecomprising at least one of the following: a CDR1 light chain encoded bythe sequence in SEQ ID NO: 12 or SEQ ID NO: 694; a light chain CDR2encoded by the sequence in SEQ ID NO: 13; a light chain CDR3 encoded bythe sequence in SEQ ID NO: 14 or SEQ ID NO: 695; a heavy chain CDR1encoded by the sequence in SEQ ID NO: 15, a heavy chain CDR2 encoded bySEQ ID NO: 16 or SEQ ID NO: 696 and a heavy chain CDR3 encoded by SEQ IDNO: 17 or SEQ ID NO: 697. In addition the invention embraces suchnucleic acid sequences and variants thereof.

In another embodiment the invention is directed to amino acid sequencescorresponding to the CDRs of said anti-IL-6 antibody which are selectedfrom SEQ ID NO: 4 (CDR1), SEQ ID NO: 5 (CDR2), SEQ ID NO: 6 (CDR3), SEQID NO: 7, SEQ ID NO: 120 and SEQ ID NO: 9.

In another embodiment the anti-IL-6 antibody of the invention comprisesa light chain nucleic acid sequence of SEQ ID NO: 10, 662, 698, 701,705, 720, 721, 722, or 723; and/or a heavy chain nucleic acid sequenceof SEQ ID NO: 11, 663, 700, 703, 707, 724, or 725. In addition theinvention is directed to the corresponding polypeptides encoded by anyof the foregoing nucleic acid sequences and combinations thereof.

In a specific embodiment of the invention the anti-IL-6 antibodies or aportion thereof will be encoded by a nucleic acid sequence selected fromthose comprised in SEQ ID NO: 10, 12, 13, 14, 662, 694, 695, 698, 701,705, 720, 721, 722, 723, 11, 15, 16, 17, 663, 696, 697, 700, 703, 707,724, and 725. For example the CDR1 in the light chain may be encoded bySEQ ID NO: 12 or 694, the CDR2 in the light chain may be encoded by SEQID NO: 13, the CDR3 in the light chain may be encoded by SEQ ID NO: 14or 695; the CDR1 in the heavy chain may be encoded by SEQ ID NO: 15, theCDR2 in the heavy chain may be encoded by SEQ ID NO: 16 or 696, the CDR3in the heavy chain may be encoded by SEQ ID NO: 17 or 697. As discussedinfra antibodies containing these CDRs may be constructed usingappropriate human frameworks based on the humanization methods disclosedherein.

In another specific embodiment of the invention the variable light chainwill be encoded by SEQ ID NO: 10, 662, 698, 701, 705, 720, 721, 722, or723 and the variable heavy chain of the anti-IL-6 antibodies will beencoded by SEQ ID NO: 11, 663, 700, 703, 707, 724, or 725.

In a more specific embodiment variable light and heavy chains of theanti-IL-6 antibody respectively will be encoded by SEQ ID NO: 10 and 11,or SEQ ID NO: 698 and SEQ ID NO: 700, or SEQ ID NO: 701 and SEQ ID NO:703 or SEQ ID NO: 705 and SEQ ID NO: 707.

In another specific embodiment the invention covers nucleic acidconstructs containing any of the foregoing nucleic acid sequences andcombinations thereof as well as recombinant cells containing thesenucleic acid sequences and constructs containing wherein these nucleicacid sequences or constructs may be extrachromosomal or integrated intothe host cell genome

In another specific embodiment the invention covers polypeptidescontaining any of the CDRs or combinations thereof recited in SEQ ID NO:4, SEQ ID NO: 5, SEQ ID NO: 6, SEQ ID NO: 7, SEQ ID NO: 8, SEQ ID NO:120, SEQ ID NO: 9 or polypeptides comprising any of the variable lightpolypeptides comprised in SEQ ID NO: 2, 20, 647, 651, 660, 666, 699,702, 706, or 709 and/or the variable heavy polypeptides comprised in SEQID NO: 3, 18, 19, 652, 656, 657, 658, 661, 664, 665, 704, or 708.

In another embodiment the anti-IL-6 antibody is one comprising at leastone of the following: a variable light chain encoded by the sequence inSEQ ID NO: 10 or SEQ ID NO: 698 or SEQ ID NO: 701 or SEQ ID NO: 705 anda variable chain encoded by the sequence in SEQ ID NO: 11 or SEQ ID NO:700 or SEQ ID NO: 703 or SEQ ID NO: 707.

In another embodiment the anti-IL-6 antibody is a variant of theforegoing sequences that includes at least one substitution in theframework and/or CDR sequences and which has at least one of theproperties of Ab1 in vitro and/or upon in vivo administration.

These in vitro and in vivo properties are described in more detail inthe examples below and include: competing with Ab1 for binding to IL-6and/or peptides thereof; having a binding affinity (Kd) for IL-6 of lessthan about 50 picomolar, and/or a rate of dissociation (K_(off)) fromIL-6 of less than or equal to 10⁻⁴ S⁻¹; having an in-vivo half-life ofat least about 22 days in a healthy human subject; ability to prevent ortreat hypoalbunemia; ability to prevent or treat elevated CRP; abilityto prevent or treat abnormal coagulation; and/or ability to decrease therisk of thrombosis in an individual having a disease or conditionassociated with increased risk of thrombosis. Additional non-limitingexamples of anti-IL-6 activity are set forth herein, for example, underthe heading “Anti-IL-6 Activity.”

In another embodiment the anti-IL-6 antibody includes at least one ofthe Ab1 light-chain and/or heavy chain CDR sequences (see Table 4) orvariant(s) thereof which has at least one of the properties of Ab1 invitro and/or upon in vivo administration (examples of such propertiesare discussed in the preceding paragraph). One of skill in the art wouldunderstand how to combine these CDR sequences to form an antigen-bindingsurface, e.g. by linkage to at least one scaffold which may comprisehuman or other mammalian framework sequences, or their functionalorthologs derived from a SMIP (Small Modular ImmunoPharmaceutical),camelbody, nanobody, IgNAR, other immunoglobulin, or other engineeredantibody. See, e.g., Robak & Robak (2011) BioDrugs 25(1): 13-25 andWesolowski, et al. (2009) Med Microbiol Immunol 198: 157-174. Forexample, embodiments may specifically bind to human IL-6 and includeone, two, three, four, five, six, or more of the following CDR sequencesor variants thereof: a polypeptide having at least 72.7% sequenceidentity (i.e., 8 out of 11 amino acids) to the light chain CDR1 of SEQID NO: 4; a polypeptide having at least 81.8% (i.e., 9 out of 11 aminoacids) identity to the light chain CDR1 of SEQ ID NO: 4; a polypeptidehaving at least 90.9% (i.e., 10 out of 11 amino acids) identity to thelight chain CDR1 of SEQ ID NO: 4; a polypeptide having 100% (i.e., 11out of 11 amino acids) identity to the light chain CDR1 of SEQ ID NO: 4;a polypeptide having at least 85.7% sequence identity (i.e., 6 out of 7amino acids) to the light chain CDR2 of SEQ ID NO: 5; a polypeptidehaving 100% (i.e., 7 out of 7 amino acids) identity to the light chainCDR2 of SEQ ID NO: 5; a polypeptide having at least 50% sequenceidentity (i.e., 6 out of 12 amino acids) to the light chain CDR3 of SEQID NO: 6; a polypeptide having at least 58.3% sequence identity (i.e., 7out of 12 amino acids) to the light chain CDR3 of SEQ ID NO: 6;

a polypeptide having at least 66.6% (i.e., 8 out of 12 amino acids)identity to the light chain CDR3 of SEQ ID NO: 6; a polypeptide havingat least 75% (i.e., 9 out of 12 amino acids) identity to the light chainCDR3 of SEQ ID NO: 6; a polypeptide having at least 83.3% sequenceidentity (i.e., 10 out of 12 amino acids) to the light chain CDR3 of SEQID NO: 6; a polypeptide having at least 91.6% sequence identity (i.e.,11 out of 12 amino acids) to the light chain CDR3 of SEQ ID NO: 6; apolypeptide having 100% (i.e., 12 out of 12 amino acids) identity to thelight chain CDR3 of SEQ ID NO: 6; a polypeptide having at least 80%sequence identity (i.e., 4 out of 5 amino acids) to the heavy chain CDR1of SEQ ID NO: 7; a polypeptide having 100% (i.e., 5 out of 5 aminoacids) identity to the heavy chain CDR1 of SEQ ID NO: 7; a polypeptidehaving at least 50% sequence identity (i.e., 8 out of 16 amino acids) tothe heavy chain CDR2 of SEQ ID NO: 120; a polypeptide having at least56.2% sequence identity (i.e., 9 out of 16 amino acids) to the heavychain CDR2 of SEQ ID NO: 120; a polypeptide having at least 62.5%sequence identity (i.e., 10 out of 16 amino acids) to the heavy chainCDR2 of SEQ ID NO: 120; a polypeptide having at least 68.7% sequenceidentity (i.e., 11 out of 16 amino acids) to the heavy chain CDR2 of SEQID NO: 120; a polypeptide having at least 75% sequence identity (i.e.,12 out of 16 amino acids) to the heavy chain CDR2 of SEQ ID NO: 120;

a polypeptide having at least 81.2% sequence identity (i.e., 13 out of16 amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; a polypeptidehaving at least 87.5% sequence identity (i.e., 14 out of 16 amino acids)to the heavy chain CDR2 of SEQ ID NO: 120; a polypeptide having at least93.7% sequence identity (i.e., 15 out of 16 amino acids) to the heavychain CDR2 of SEQ ID NO: 120; a polypeptide having 100% (i.e., 16 out of16 amino acids) identity to the heavy chain CDR2 of SEQ ID NO: 120; apolypeptide having at least 33.3% sequence identity (i.e., 4 out of 12amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; a polypeptidehaving at least 41.6% (i.e., 5 out of 12 amino acids) identity to theheavy chain CDR3 of SEQ ID NO: 9; a polypeptide having at least 50%sequence identity (i.e., 6 out of 12 amino acids) to the heavy chainCDR3 of SEQ ID NO: 9; a polypeptide having at least 58.3% sequenceidentity (i.e., 7 out of 12 amino acids) to the heavy chain CDR3 of SEQID NO: 9; a polypeptide having at least 66.6% sequence identity (i.e., 8out of 12 amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; apolypeptide having at least 75% sequence identity (i.e., 9 out of 12amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; a polypeptidehaving at least 83.3% sequence identity (i.e., 10 out of 12 amino acids)to the heavy chain CDR3 of SEQ ID NO: 9; a polypeptide having at least91.6% sequence identity (i.e., 11 out of 12 amino acids) to the heavychain CDR3 of SEQ ID NO: 9; a polypeptide having 100% (i.e., 12 out of12 amino acids) identity to the heavy chain CDR3 of SEQ ID NO: 9; apolypeptide having at least 90.9% sequence identity (i.e., 10 out of 11amino acids) to the light chain CDR1 of SEQ ID NO: 4; a polypeptidehaving 100% (i.e., 11 out of 11 amino acids) similarity to the lightchain CDR1 of SEQ ID NO: 4; a polypeptide having at least 85.7% sequenceidentity (i.e., 6 out of 7 amino acids) to the light chain CDR2 of SEQID NO: 5; a polypeptide having 100% (i.e., 7 out of 7 amino acids)similarity to the light chain CDR2 of SEQ ID NO: 5; a polypeptide havingat least 66.6% sequence identity (i.e., 8 out of 12 amino acids) to thelight chain CDR3 of SEQ ID NO: 6; a polypeptide having at least 75%sequence identity (i.e., 9 out of 12 amino acids) to the light chainCDR3 of SEQ ID NO: 6; a polypeptide having at least 83.3% sequenceidentity (i.e., 10 out of 12 amino acids) to the light chain CDR3 of SEQID NO: 6; a polypeptide having at least 91.6% sequence identity (i.e.,11 out of 12 amino acids) to the light chain CDR3 of SEQ ID NO: 6; apolypeptide having 100% (i.e., 12 out of 12 amino acids) similarity tothe light chain CDR3 of SEQ ID NO: 6; a polypeptide having at least 80%sequence identity (i.e., 4 out of 5 amino acids) to the heavy chain CDR1of SEQ ID NO: 7; a polypeptide having 100% (i.e., 5 out of 5 aminoacids) similarity to the heavy chain CDR1 of SEQ ID NO: 7; a polypeptidehaving at least 56.2% sequence identity (i.e., 9 out of 16 amino acids)to the heavy chain CDR2 of SEQ ID NO: 120; a polypeptide having at least62.5% sequence identity (i.e., 10 out of 16 amino acids) to the heavychain CDR2 of SEQ ID NO: 120; a polypeptide having at least 68.7%sequence identity (i.e., 11 out of 16 amino acids) to the heavy chainCDR2 of SEQ ID NO: 120; a polypeptide having at least 75% sequenceidentity (i.e., 12 out of 16 amino acids) to the heavy chain CDR2 of SEQID NO: 120; a polypeptide having at least 81.2% sequence identity (i.e.,13 out of 16 amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; apolypeptide having at least 87.5% sequence identity (i.e., 14 out of 16amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; a polypeptidehaving at least 93.7% sequence identity (i.e., 15 out of 16 amino acids)to the heavy chain CDR2 of SEQ ID NO: 120; a polypeptide having 100%(i.e., 16 out of 16 amino acids) similarity to the heavy chain CDR2 ofSEQ ID NO: 120; a polypeptide having at least 50% sequence similarity(i.e., 6 out of 12 amino acids) to the heavy chain CDR3 of SEQ ID NO: 9;a polypeptide having at least 58.3% sequence identity (i.e., 7 out of 12amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; a polypeptidehaving at least 66.6% sequence identity (i.e., 8 out of 12 amino acids)to the heavy chain CDR3 of SEQ ID NO: 9; a polypeptide having at least75% sequence identity (i.e., 9 out of 12 amino acids) to the heavy chainCDR3 of SEQ ID NO: 9; a polypeptide having at least 83.3% sequenceidentity (i.e., 10 out of 12 amino acids) to the heavy chain CDR3 of SEQID NO: 9; a polypeptide having at least 91.6% sequence identity (i.e.,11 out of 12 amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; or apolypeptide having 100% (i.e., 12 out of 12 amino acids) similarity tothe heavy chain CDR3 of SEQ ID NO: 9.

Other exemplary embodiments include at least one polynucleotidesencoding any of the foregoing, e.g., a polynucleotide encoding apolypeptide that specifically binds to human IL-6 and includes one, two,three, four, five, six, or more of the following CDRs or variantsthereof:

a polynucleotide encoding a polypeptide having at least 72.7% sequenceidentity (i.e., 8 out of 11 amino acids) to the light chain CDR1 of SEQID NO: 4; a polynucleotide encoding a polypeptide having at least 81.8%sequence identity (i.e., 9 out of 11 amino acids) to the light chainCDR1 of SEQ ID NO: 4; a polynucleotide encoding a polypeptide having atleast 90.9% sequence identity (i.e., 10 out of 11 amino acids) to thelight chain CDR1 of SEQ ID NO: 4; a polynucleotide encoding apolypeptide having 100% sequence identity to the light chain CDR1 of SEQID NO: 4; a polynucleotide encoding a polypeptide having at least 85.7%sequence identity (i.e., 6 out of 7 amino acids) to the light chain CDR2of SEQ ID NO: 5; a polynucleotide encoding a polypeptide having 100%sequence identity to the light chain CDR2 of SEQ ID NO: 5; apolynucleotide encoding a polypeptide having at least 50% sequenceidentity (i.e., 6 out of 12 amino acids) to the light chain CDR3 of SEQID NO: 6; a polynucleotide encoding a polypeptide having at least 58.3%sequence identity (i.e., 7 out of 12 amino acids) to the light chainCDR3 of SEQ ID NO: 6; a polynucleotide encoding a polypeptide having atleast 66.6% sequence identity (i.e., 8 out of 12 amino acids) to thelight chain CDR3 of SEQ ID NO: 6; a polynucleotide encoding apolypeptide having at least 75% sequence identity (i.e., 9 out of 12amino acids) to the light chain CDR3 of SEQ ID NO: 6; a polynucleotideencoding a polypeptide having at least 83.3% sequence identity (i.e., 10out of 12 amino acids) to the light chain CDR3 of SEQ ID NO: 6; apolynucleotide encoding a polypeptide having at least 91.6% sequenceidentity (i.e., 11 out of 12 amino acids) to the light chain CDR3 of SEQID NO: 6; a polynucleotide encoding a polypeptide having 100% identityto the light chain CDR3 of SEQ ID NO: 6; a polynucleotide encoding apolypeptide having at least 80% sequence identity (i.e., 4 out of 5amino acids) to the heavy chain CDR1 of SEQ ID NO: 7; a polynucleotideencoding a polypeptide having 100% identity to the heavy chain CDR1 ofSEQ ID NO: 7; a polynucleotide encoding a polypeptide having at least50% sequence identity (i.e., 8 out of 16 amino acids) to the heavy chainCDR2 of SEQ ID NO: 120; a polynucleotide encoding a polypeptide havingat least 56.2% sequence identity (i.e., 9 out of 16 amino acids) to theheavy chain CDR2 of SEQ ID NO: 120; a polynucleotide encoding apolypeptide having at least 62.5% sequence identity (i.e., 10 out of 16amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; a polynucleotideencoding a polypeptide having at least 68.7% sequence identity (i.e., 11out of 16 amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; apolynucleotide encoding a polypeptide having at least 75% sequenceidentity (i.e., 12 out of 16 amino acids) to the heavy chain CDR2 of SEQID NO: 120; a polynucleotide encoding a polypeptide having at least81.2% sequence identity (i.e., 13 out of 16 amino acids) to the heavychain CDR2 of SEQ ID NO: 120; a polynucleotide encoding a polypeptidehaving at least 87.5% sequence identity (i.e., 14 out of 16 amino acids)to the heavy chain CDR2 of SEQ ID NO: 120; a polynucleotide encoding apolypeptide having at least 93.7% sequence identity (i.e., 15 out of 16amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; a polynucleotideencoding a polypeptide having 100% identity to the heavy chain CDR2 ofSEQ ID NO: 120; a polynucleotide encoding a polypeptide having at least33.3% sequence identity (i.e., 4 out of 12 amino acids) to the heavychain CDR3 of SEQ ID NO: 9; a polynucleotide encoding a polypeptidehaving at least 41.6% (i.e., 5 out of 12 amino acids) identity to theheavy chain CDR3 of SEQ ID NO: 9; a polynucleotide encoding apolypeptide having at least 50% sequence identity (i.e., 6 out of 12amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; a polynucleotideencoding a polypeptide having at least 58.3% sequence identity (i.e., 7out of 12 amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; apolynucleotide encoding a polypeptide having at least 66.6% sequenceidentity (i.e., 8 out of 12 amino acids) to the heavy chain CDR3 of SEQID NO: 9; a polynucleotide encoding a polypeptide having at least 75%sequence identity (i.e., 9 out of 12 amino acids) to the heavy chainCDR3 of SEQ ID NO: 9; a polynucleotide encoding a polypeptide having atleast 83.3% sequence identity (i.e., 10 out of 12 amino acids) to theheavy chain CDR3 of SEQ ID NO: 9; a polynucleotide encoding apolypeptide having at least 91.6% sequence identity (i.e., 11 out of 12amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; a polynucleotideencoding a polypeptide having 100% (i.e., 12 out of 12 amino acids)identity to the heavy chain CDR3 of SEQ ID NO: 9; a polynucleotideencoding a polypeptide having at least 90.9% sequence identity (i.e., 10out of 11 amino acids) to the light chain CDR1 of SEQ ID NO: 4; apolynucleotide encoding a polypeptide having 100% sequence similarity tothe light chain CDR1 of SEQ ID NO: 4; a polynucleotide encoding apolypeptide having at least 85.7% sequence identity (i.e., 6 out of 7amino acids) to the light chain CDR2 of SEQ ID NO: 5; a polynucleotideencoding a polypeptide having 100% sequence similarity to the lightchain CDR2 of SEQ ID NO: 5; a polynucleotide encoding a polypeptidehaving at least 66.6% sequence identity (i.e., 8 out of 12 amino acids)to the light chain CDR3 of SEQ ID NO: 6; a polynucleotide encoding apolypeptide having at least 75% sequence identity (i.e., 9 out of 12amino acids) to the light chain CDR3 of SEQ ID NO: 6; a polynucleotideencoding a polypeptide having at least 83.3% sequence identity (i.e., 10out of 12 amino acids) to the light chain CDR3 of SEQ ID NO: 6; apolynucleotide encoding a polypeptide having at least 91.6% sequenceidentity (i.e., 11 out of 12 amino acids) to the light chain CDR3 of SEQID NO: 6; a polynucleotide encoding a polypeptide having 100% sequencesimilarity to the light chain CDR3 of SEQ ID NO: 6; a polynucleotideencoding a polypeptide having at least 80% sequence identity (i.e., 4out of 5 amino acids) to the heavy chain CDR1 of SEQ ID NO: 7; apolynucleotide encoding a polypeptide having 100% sequence similarity tothe heavy chain CDR1 of SEQ ID NO: 7; a polynucleotide encoding apolypeptide having at least 56.2% sequence identity (i.e., 9 out of 16amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; a polynucleotideencoding a polypeptide having at least 62.5% sequence identity (i.e., 10out of 16 amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; apolynucleotide encoding a polypeptide having at least 68.7% sequenceidentity (i.e., 11 out of 16 amino acids) to the heavy chain CDR2 of SEQID NO: 120; a polynucleotide encoding a polypeptide having at least 75%sequence identity (i.e., 12 out of 16 amino acids) to the heavy chainCDR2 of SEQ ID NO: 120; a polynucleotide encoding a polypeptide havingat least 81.2% sequence identity (i.e., 13 out of 16 amino acids) to theheavy chain CDR2 of SEQ ID NO: 120; a polynucleotide encoding apolypeptide having at least 87.5% sequence identity (i.e., 14 out of 16amino acids) to the heavy chain CDR2 of SEQ ID NO: 120; a polynucleotideencoding a polypeptide having at least 93.7% sequence identity (i.e., 15out of 16 amino acids) to the heavy chain CDR2 of SEQ ID NO: 120;

a polynucleotide encoding a polypeptide having 100% sequence similarity(i.e., 16 out of 16 amino acids) to the heavy chain CDR2 of SEQ ID NO:120; a polynucleotide encoding a polypeptide having at least 50%sequence similarity (i.e., 6 out of 12 amino acids) to the heavy chainCDR3 of SEQ ID NO: 9; a polynucleotide encoding a polypeptide having atleast 58.3% sequence identity (i.e., 7 out of 12 amino acids) to theheavy chain CDR3 of SEQ ID NO: 9; a polynucleotide encoding apolypeptide having at least 66.6% sequence identity (i.e., 8 out of 12amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; a polynucleotideencoding a polypeptide having at least 75% sequence identity (i.e., 9out of 12 amino acids) to the heavy chain CDR3 of SEQ ID NO: 9; apolynucleotide encoding a polypeptide having at least 83.3% sequenceidentity (i.e., 10 out of 12 amino acids) to the heavy chain CDR3 of SEQID NO: 9; a polynucleotide encoding a polypeptide having at least 91.6%sequence identity (i.e., 11 out of 12 amino acids) to the heavy chainCDR3 of SEQ ID NO: 9; a polynucleotide encoding a polypeptide having100% sequence similarity (i.e., 12 out of 12 amino acids) to the heavychain CDR3 of SEQ ID NO: 9.

TABLE 4 Sequences of exemplary anti-IL-6 antibodies. Antibody chainsCDR1 CDR2 CDR3 Antibody PRT. Nuc. PRT. Nuc. PRT. Nuc. PRT. Nuc. Ab1light chains * 2 10 4 12 5 13 6 14 20 720 4 12 5 13 6 14 647 721 4 12 513 6 14 651 4 12 5 13 6 14 660 662 4 12 5 13 6 14 666 722 4 12 5 13 6 14699 698 4 694 5 13 6 695 702 701 4 694 5 13 6 695 706 705 4 694 5 13 6695 709 723 4 12 5 13 6 14 Human light 648 710 713 chains used in 649711 714 Ab1 humanization 650 712 715 Ab1 heavy chains 3 11 7 15 8 16 917 18 7 15 8 16 9 17 19 724 7 15 120 696 9 17 652 725 7 15 8 16 9 17 6567 15 8 16 9 17 657 700 7 15 659 696 9 697 658 7 15 120 696 9 17 661 6637 15 8 16 9 17 664 7 15 8 16 9 17 665 7 15 120 696 9 17 704 703 7 15 120696 9 697 708 707 7 15 120 696 9 697 Human heavy 653 716 717 chains usedin 654 716 717 Ab1 humanization 655 74 82 718 Ab2 light chains 21 29 2331 24 32 25 33 667 669 23 31 24 32 25 33 Ab2 heavy chains 22 30 26 34 2735 28 36 668 670 26 34 27 35 28 36 Ab3 light chains 37 45 39 47 40 48 4149 671 673 39 47 40 48 41 49 Ab3 heavy chains 38 46 42 50 43 51 44 52672 674 42 50 43 51 44 52 Ab4 light chains 53 61 55 63 56 64 57 65 675677 55 63 56 64 57 65 Ab4 heavy chains 54 62 58 66 59 67 60 68 676 67858 66 59 67 60 68 Ab5 light chains 69 77 71 79 72 80 73 81 679 681 71 7972 80 73 81 Ab5 heavy chains 70 78 74 82 75 83 76 84 680 682 74 82 75 8376 84 Ab6 light chains 85 93 87 95 88 96 89 97 683 685 87 95 88 96 89 97Ab6 heavy chains 86 94 90 98 91 99 92 100 684 686 90 98 91 99 92 100 Ab7light chains 101 109 103 111 104 112 105 113 119 103 111 104 112 105 113687 689 103 111 104 112 105 113 693 103 111 104 112 105 113 Ab7 heavychains 102 110 106 114 107 115 108 116 117 106 114 107 115 108 116 118106 114 121 108 116 688 690 106 114 107 115 108 116 691 106 114 107 115108 116 692 106 114 121 108 116 Ab8 light chain 122 130 124 132 125 133126 134 Ab8 heavy chain 123 131 127 135 128 136 129 137 Ab9 light chain138 146 140 148 141 149 142 150 Ab9 heavy chain 139 147 143 151 144 152145 153 Ab10 light chain 154 162 156 164 157 165 158 166 Ab10 heavychain 155 163 159 167 160 168 161 169 Ab11 light chain 170 178 172 180173 181 174 182 Ab11 heavy chain 171 179 175 183 176 184 177 185 Ab12light chain 186 194 188 196 189 197 190 198 Ab12 heavy chain 187 195 191199 192 200 193 201 Ab13 light chain 202 210 204 212 205 213 206 214Ab13 heavy chain 203 211 207 215 208 216 209 217 Ab14 light chain 218226 220 228 221 229 222 230 Ab14 heavy chain 219 227 223 231 224 232 225233 Ab15 light chain 234 242 236 244 237 245 238 246 Ab15 heavy chain235 243 239 247 240 248 241 249 Ab16 light chain 250 258 252 260 253 261254 262 Ab16 heavy chain 251 259 255 263 256 264 257 265 Ab17 lightchain 266 274 268 276 269 277 270 278 Ab17 heavy chain 267 275 271 279272 280 273 281 Ab18 light chain 282 290 284 292 285 293 286 294 Ab18heavy chain 283 291 287 295 288 296 289 297 Ab19 light chain 298 306 300308 301 309 302 310 Ab19 heavy chain 299 307 303 311 304 312 305 313Ab20 light chain 314 322 316 324 317 325 318 326 Ab20 heavy chain 315323 319 327 320 328 321 329 Ab21 light chain 330 338 332 340 333 341 334342 Ab21 heavy chain 331 339 335 343 336 344 337 345 Ab22 light chain346 354 348 356 349 357 350 358 Ab22 heavy chain 347 355 351 359 352 360353 361 Ab23 light chain 362 370 364 372 365 373 366 374 Ab23 heavychain 363 371 367 375 368 376 369 377 Ab24 light chain 378 386 380 388381 389 382 390 Ab24 heavy chain 379 387 383 391 384 392 385 393 Ab25light chain 394 402 396 404 397 405 398 406 Ab25 heavy chain 395 403 399407 400 408 401 409 Ab26 light chain 410 418 412 420 413 421 414 422Ab26 heavy chain 411 419 415 423 416 424 417 425 Ab27 light chain 426434 428 436 429 437 430 438 Ab27 heavy chain 427 435 431 439 432 440 433441 Ab28 light chain 442 450 444 452 445 453 446 454 Ab28 heavy chain443 451 447 455 448 456 449 457 Ab29 light chain 458 466 460 468 461 469462 470 Ab29 heavy chain 459 467 463 471 464 472 465 473 Ab30 lightchain 474 482 476 484 477 485 478 486 Ab30 heavy chain 475 483 479 487480 488 481 489 Ab31 light chain 490 498 492 500 493 501 494 502 Ab31heavy chain 491 499 495 503 496 504 497 505 Ab32 light chain 506 514 508516 509 517 510 518 Ab32 heavy chain 507 515 511 519 512 520 513 521Ab33 light chain 522 530 524 532 525 533 526 534 Ab33 heavy chain 523531 527 535 528 536 529 537 Ab34 light chain 538 546 540 548 541 549 542550 Ab34 heavy chain 539 547 543 551 544 552 545 553 Ab35 light chain554 562 556 564 557 565 558 566 Ab35 heavy chain 555 563 559 567 560 568561 569 Ab36 light chain 570 578 572 580 573 581 574 582 Ab36 heavychain 571 579 575 583 576 584 577 585 * Exemplary sequence variant formsof heavy and light chains are shown on separate lines. (PRT.:Polypeptide sequence Nuc.: Exemplary coding sequence)

For reference, sequence identifiers other than those included in Table 4are summarized in Table 5.

TABLE 5 Summary of sequence identifiers in this application. SEQ IDDescription  1 Human IL-6 586 kappa constant light chain polypeptidesequence 587 kappa constant light chain polynucleotide sequence 588gamma-1 constant heavy chain polypeptide sequence 589 gamma-1 constantheavy chain polynucleotide sequence 590-646 Human IL-6 peptides (Example14) 719 gamma-1 constant heavy chain polypeptide sequence (differs fromSEQ ID NO: 518 at two positions) 726 C-reactive protein polypeptidesequence 727 IL-6 receptor alpha 728 IL-6 receptor beta/gp130

Such antibody fragments or variants thereof may be present in at leastone of the following non-limiting forms: Fab, Fab′, F(ab′)2, Fv andsingle chain Fv antibody forms. In a preferred embodiment, the anti-IL-6antibodies described herein further comprises the kappa constant lightchain sequence comprising the sequence set forth in the polypeptidesequence of SEQ ID NO: 586.

In another preferred embodiment, the anti-IL-6 antibodies describedherein further comprises the gamma-1 constant heavy chain polypeptidesequence comprising one of the sequences set forth in the polypeptidesequence of SEQ ID NO: 588 and SEQ ID NO: 719.

Embodiments of antibodies described herein may include a leadersequence, such as a rabbit Ig leader, albumin pre-peptide, a yeastmating factor pre pro secretion leader sequence (such as P. pastoris orSaccharomyces cerevisiae a or alpha factor), or human HAS leader.Exemplary leader sequences are shown offset from FR1 at the N-terminusof polypeptides shown in FIGS. 4A-B and 5A-B as follows: rabbit Igleader sequences in SEQ ID NOs: 2 and 660 and SEQ ID NOs: 3 and 661; andan albumin prepeptide in SEQ ID NOs: 706 and 708, which facilitatessecretion. Other leader sequences known in the art to confer desiredproperties, such as secretion, improved stability or half-life, may alsobe used, either alone or in combinations with one another, on the heavyand/or light chains, which may optionally be cleaved prior toadministration to a subject. For example, a polypeptide may be expressedin a cell or cell-free expression system that also expresses or includes(or is modified to express or include) a protease, e.g., amembrane-bound signal peptidase, that cleaves a leader sequence.

In another embodiment, the invention contemplates an isolated anti-IL-6antibody comprising a V_(H) polypeptide sequence comprising: SEQ ID NO:3, 18, 19, 22, 38, 54, 70, 86, 102, 117, 118, 123, 139, 155, 171, 187,203, 219, 235, 251, 267, 283, 299, 315, 331, 347, 363, 379, 395, 411,427, 443, 459, 475, 491, 507, 523, 539, 555, 571, 652, 656, 657, 658,661, 664, 665, 668, 672, 676, 680, 684, 688, 691, 692, 704, or 708; andfurther comprising a V_(L) polypeptide sequence comprising: SEQ ID NO:2, 20, 21, 37, 53, 69, 85, 101, 119, 122, 138, 154, 170, 186, 202, 218,234, 250, 266, 282, 298, 314, 330, 346, 362, 378, 394, 410, 426, 442,458, 474, 490, 506, 522, 538, 554, 570, 647, 651, 660, 666, 667, 671,675, 679, 683, 687, 693, 699, 702, 706, or 709 or a variant thereofwherein at least one of the framework residues (FR residues) or CDRresidues in said V_(H) or V_(L) polypeptide has been substituted withanother amino acid residue resulting in an anti-IL-6 antibody thatspecifically binds IL-6. The invention contemplates humanized andchimeric forms of these antibodies wherein preferably the FR willcomprise human FRs highly homologous to the parent antibody. Thechimeric antibodies may include an Fc derived from IgG1, IgG2, IgG3,IgG4, IgG5, IgG6, IgG7, IgG8, IgG9, IgG10, IgG11, IgG12, IgG13, IgG14,IgG15, IgG16, IgG17, IgG18 or IgG19 constant regions and in particular avariable heavy and light chain constant region as set forth in SEQ IDNO: 588 and SEQ ID NO: 586.

In one embodiment of the invention, the antibodies or V_(H) or V_(L)polypeptides originate or are selected from at least one rabbit B cellpopulations prior to initiation of the humanization process referencedherein.

In another embodiment of the invention, the anti-IL-6 antibodies andfragments and variants thereof have binding specificity for primatehomologs of the human IL-6 protein. Non-limiting examples of primatehomologs of the human IL-6 protein are IL-6 obtained from Macacafascicularis (cynomolgus monkey) and the Rhesus monkey. In anotherembodiment of the invention, the anti-IL-6 antibodies and fragments andvariants thereof inhibits the association of IL-6 with IL-6R, and/or theproduction of IL-6/IL-6R/gp130 complexes and/or the production ofIL-6/IL-6R/gp130 multimers and/or antagonizes the biological effects ofat least one of the foregoing.

Polyclonal Antibody

Polyclonal antibodies are heterogeneous populations of antibodymolecules derived from the sera of animals immunized with an antigen.Polyclonal antibodies which selectively bind the IL-6 may be made bymethods well-known in the art. See, e.g., Howard & Kaser (2007) Makingand Using Antibodies: A Practical Handbook CRC Press.

Monoclonal Antibody

A monoclonal antibody contains a substantially homogeneous population ofantibodies specific to antigens, which population contains substantiallysimilar epitope binding sites. Monoclonal antibodies may be obtained bymethods known to those skilled in the art. See, e.g. Kohler and Milstein(1975) Nature 256: 495-497; U.S. Pat. No. 4,376,110; Ausubel, et al.[Eds.] (2011) CURRENT PROTOCOLS IN MOLECULAR BIOLOGY, Greene PublishingAssoc. and Wiley Interscience, NY.; and Harlow & Lane (1998) USINGANTIBODIES: A LABORATORY MANUAL Cold Spring Harbor Laboratory; Colligan,et al. (2005) [Eds.] Current Protocols in Immunology Greene PublishingAssoc. and Wiley Interscience, NY. Such antibodies may be of anyimmunoglobulin class including IgG, IgM, IgE, IgA, GILD, and anysubclass thereof. A hybridoma producing an antibody of the presentinvention may be cultivated in vitro, in situ, or in vivo.

Chimeric Antibody

Chimeric antibodies are molecules different portions of which arederived from different animal species, such as those having variableregion derived from a murine antibody and a human immunoglobulinconstant region, which are primarily used to reduce immunogenicity inapplication and to increase yields in production, for example, wheremurine monoclonal antibodies have higher yields from hybridomas buthigher immunogenicity in humans, such that human murine chimericmonoclonal antibodies are used. Chimeric antibodies and methods fortheir production are known in the art. See Cabilly, et al. (1984) Proc.Natl. Acad. Sci. USA 81: 3273-3277; Morrison, et al. (1994) Proc. Natl.Acad. Sci. USA 81: 6851-6855, Boulianne, et al. (1984) Nature 312:643-646; Neuberger, et al. (1985) Nature 314: 268-270; European PatentApplication 173494 (1986); WO 86/01533 (1986); European Patent 184187(1992); Sahagan, et al. (1986) J Immunol. 137: 1066-1074; Liu, et al.(1987) Proc. Natl. Acad. Sci. USA 84: 3439-3443; Sun, et al. (1987)Proc. Natl. Acad. Sci. USA 84: 214-218; Better, et al. (1988) Science240: 1041-1043; and Harlow & Lane (1998) USING ANTIBODIES: A LABORATORYMANUAL Cold Spring Harbor Laboratory; and U.S. Pat. No. 5,624,659.

Humanized Antibody

Humanized antibodies are engineered to contain even more human-likeimmunoglobulin domains, and incorporate only thecomplementarity-determining regions of the animal-derived antibody. Thismay be accomplished by examining the sequence of the hyper-variableloops of the variable regions of the monoclonal antibody, and fittingthem to the structure of the human antibody chains. See, e.g., U.S. Pat.No. 6,187,287. Likewise, other methods of producing humanized antibodiesare now well known in the art. See, e.g., U.S. Pat. Nos. 5,225,539;5,530,101; 5,585,089; 5,693,762; 6,054,297; 6,180,370; 6,407,213;6,548,640; 6,632,927; and 6,639,055; Jones, et al. (1986) Nature 321:522-525; Reichmann, et al. (1988) Nature 332: 323-327; Verhoeyen, et al.(1988) Science 239: 1534-36; and Zhiqiang An (2009) [Ed.] TherapeuticMonoclonal Antibodies: From Bench to Clinic John Wiley & Sons, Inc.

Antibody Fragments (Antigen-Binding Fragments)

In addition to entire immunoglobulins (or their recombinantcounterparts), immunoglobulin fragments comprising the epitope bindingsite (e.g., Fab′, F(ab′)2, or other fragments) may be synthesized.“Fragment,” or minimal immunoglobulins may be designed utilizingrecombinant immunoglobulin techniques. For instance “Fv” immunoglobulinsfor use in the present invention may be produced by synthesizing a fusedvariable light chain region and a variable heavy chain region.Combinations of antibodies are also of interest, e.g. diabodies, whichcomprise two distinct Fv specificities. Antibody fragments ofimmunoglobulins include but are not limited to SMIPs (small moleculeimmunopharmaceuticals), camelbodies, nanobodies, and IgNAR. Further,antigen-binding fragments may comprise the epitope binding site and havethe same antigen binding selectivity as the antibody.

An antigen-binding fragment (e.g., Fab fragment) may comprise at leastone constant and one variable domain of each of the heavy and the lightchain of the antibody from which it is derived. These domains shape theparatope—the antigen-binding site—at the amino terminal end of themonomer. The two variable domains bind the epitope on their specificantigens. Fc and Fab fragments may be generated using papain thatcleaves the immunoglobulin monomer into two Fab fragments and an Fcfragment. Pepsin cleaves below hinge region, so a F(ab′)₂ fragment and apFc′ fragment may be formed. Another enzyme, IdeS (Immunoglobulindegrading enzyme from Streptococcus pyogenes, trade name FabRICATOR®)cleaves IgG in a sequence specific manner at neutral pH. The F(ab′)₂fragment may be split into two Fab′ fragments by mild reduction.Additionally, the variable regions of the heavy and light chains may befused together to form a single-chain variable fragment (scFv), which isonly half the size of the Fab fragment, but retains the originalspecificity of the parent antibody.

Anti-Idiotypic Antibody

An anti-idiotypic (anti-Id) antibody is an antibody which recognizesunique determinants generally associated with the antigen-binding siteof an antibody. An Id antibody may be prepared by immunizing an animalof the same species and genetic type (e.g., mouse strain) as the sourceof the antibody with the antibody to which an anti-Id is being prepared.The immunized animal will recognize and respond to the idiotypicdeterminants of the immunizing antibody by producing an antibody tothese idiotypic determinants (the anti-Id antibody). See e.g., U.S. Pat.No. 4,699,880. The anti-Id antibody may also be used as an “immunogen”to induce an immune response in yet another animal, producing aso-called anti-anti-Id antibody. The anti-anti-Id may be epitopicallyidentical to the original antibody which induced the anti-Id. Thus, byusing antibodies to the idiotypic determinants of an antibody it ispossible to identify other clones expressing antibodies of identicalspecificity.

Engineered and Modified Antibodies

An antibody of the invention further may be prepared using an antibodyhaving at least one of the VH and/or VL sequences derived from anantibody starting material to engineer a modified antibody, whichmodified antibody may have altered properties from the startingantibody. An antibody may be engineered by modifying at least oneresidues within one or both variable regions (i.e., VH and/or VL), forexample within at least one CDR regions and/or within at least oneframework regions. Additionally or alternatively, an antibody may beengineered by modifying residues within the constant region(s), forexample to alter the effector function(s) of the antibody.

One type of variable region engineering that may be performed is CDRgrafting. Antibodies interact with target antigens predominantly throughamino acid residues that are located in the six heavy and light chaincomplementarity determining regions (CDRs). For this reason, the aminoacid sequences within CDRs are more diverse between individualantibodies than sequences outside of CDRs. Because CDR sequences areresponsible for most antibody-antigen interactions, it is possible toexpress recombinant antibodies that mimic the properties of specificnaturally occurring antibodies by constructing expression vectors thatinclude CDR sequences from the specific naturally occurring antibodygrafted onto framework sequences from a different antibody withdifferent properties. See, e.g., Riechmann, et al. (1998) Nature 332:323-327; Jones, et al. (1986) Nature 321: 522-525; Queen, et al. (1989)Proc. Natl. Acad. U.S.A. 86: 10029-10033; U.S. Pat. Nos. 5,225,539;5,530,101; 5,585,089; 5,693,762; and 6,180,370.

Suitable framework sequences may be obtained from public DNA databasesor published references that include germline antibody gene sequences.For example, germline DNA sequences for human heavy and light chainvariable region genes may be found in the “VBase” human germlinesequence database (available on the Internet), as well as in Kabat, E.A., et al. (1991) Sequences of Proteins of Immunological Interest, FifthEdition, U.S. Department of Health and Human Services, NIH PublicationNo. 91-3242; Tomlinson, et al. (1992) “The Repertoire of Human GermlineVH Sequences Reveals about Fifty Groups of VH Segments with DifferentHypervariable Loops” J. Mol. Biol. 227: 776-798; and Cox, et al. (1994)Eur. J Immunol. 24: 827-836.

Another type of variable region modification is to mutate amino acidresidues within the VH and/or VL CDR 1, CDR2 and/or CDR3 regions tothereby improve at least one binding properties (e.g., affinity) of theantibody of interest. Site-directed mutagenesis or PCR-mediatedmutagenesis may be performed to introduce the mutation(s) and the effecton antibody binding, or other functional property of interest, may beevaluated in appropriate in vitro or in vivo assays. Preferablyconservative modifications (as discussed herein) may be introduced. Themutations may be amino acid substitutions, additions or deletions, butare preferably substitutions. Moreover, typically no more than one, two,three, four or five residues within a CDR region are altered.

Engineered antibodies of the invention include those in whichmodifications have been made to framework residues within VH and/or VL,e.g. to improve the properties of the antibody. Typically such frameworkmodifications are made to decrease the immunogenicity of the antibody.For example, one approach is to “backmutate” at least one frameworkresidues to the corresponding germline sequence. More specifically, anantibody that has undergone somatic mutation may contain frameworkresidues that differ from the germline sequence from which the antibodyis derived. Such residues may be identified by comparing the antibodyframework sequences to the germline sequences from which the antibody isderived.

In addition or alternative to modifications made within the framework orCDR regions, antibodies of the invention may be engineered to includemodifications within the Fc region, typically to alter at least onefunctional properties of the antibody, such as serum half-life,complement fixation, Fc receptor binding, and/or antigen-dependentcellular cytotoxicity. Furthermore, an antibody of the invention may bechemically modified (e.g., at least one chemical moieties may beattached to the antibody) or be modified to alter its glycosylation,again to alter at least one functional properties of the antibody. Suchembodiments are described further below. The numbering of residues inthe Fc region is that of the EU index of Kabat.

The hinge region of CH1 may be modified such that the number of cysteineresidues in the hinge region is altered, e.g., increased or decreased.See U.S. Pat. No. 5,677,425. The number of cysteine residues in thehinge region of CH1 may be altered to, for example, facilitate assemblyof the light and heavy chains or to increase or decrease the stabilityof the antibody. The Fc hinge region of an antibody may be mutated todecrease the biological half life of the antibody. More specifically, atleast one amino acid mutations may be introduced into the CH2-CH3 domaininterface region of the Fc-hinge fragment such that the antibody hasimpaired Staphylococcyl protein A (SpA) binding relative to nativeFc-hinge domain SpA binding. See, e.g., U.S. Pat. No. 6,165,745.

The antibody may be modified to increase its biological half life.Various approaches are possible. For example, at least one of thefollowing mutations may be introduced: T252L, T254S, T256F. See U.S.Pat. No. 6,277,375. Alternatively, to increase the biological half life,the antibody may be altered within the CH1 or CL region to contain asalvage receptor binding epitope taken from two loops of a CH2 domain ofan Fc region of an IgG. See U.S. Pat. Nos. 5,869,046 and 6,121,022.

The Fc region may be altered by replacing at least one amino acidresidue with a different amino acid residue to alter the effectorfunction(s) of the antibody. For example, at least one amino acidsselected from amino acid residues 234, 235, 236, 237, 297, 318, 320 and322 may be replaced with a different amino acid residue such that theantibody has an altered affinity for an effector ligand but retains theantigen-binding ability of the parent antibody. The effector ligand towhich affinity may be altered may be, for example, an Fc receptor or theC1 component of complement. See U.S. Pat. Nos. 5,624,821 and 5,648,260.

The Fc region may be modified to increase the affinity of the antibodyfor an Fcy receptor by modifying at least one amino acids at thefollowing positions: 238, 239, 248, 249, 252, 254, 255, 256, 258, 265,267, 268, 269, 270, 272, 276, 278, 280, 283, 285, 286, 289, 290, 292,293, 294, 295, 296, 298, 301, 303, 305, 307, 309, 312, 315, 320, 322,324, 326, 327, 329, 330, 331, 333, 334, 335, 337, 338, 340, 360, 373,376, 378, 382, 388, 389, 398, 414, 416, 419, 430, 434, 435, 437, 438 or439. See WO 00/42072. Moreover, the binding sites on human IgG1 forFcγRI, FcγRII, FcγRIII and FcRn have been mapped and variants withimproved binding. See Shields, et al. (2001) J. Biol. Chem. 276:6591-6604. Specific mutations at positions 256, 290, 298, 333, 334 and339 are shown to improve binding to FcγRIII. Additionally, the followingcombination mutants are shown to improve FcγRIII binding: T256A/S298A,S298A/E333A, S298A/K224A and S298A/E333A/K334A.

The glycosylation of an antibody may be modified. For example, anaglycoslated antibody may be made (i.e., the antibody lacksglycosylation). Glycosylation may be altered to, for example, increasethe affinity of the antibody for antigen. Such carbohydratemodifications may be accomplished by, for example, altering at least onesites of glycosylation within the antibody sequence. For example, atleast one amino acid substitutions may be made that result inelimination of at least one variable region framework glycosylationsites to thereby eliminate glycosylation at that site. Suchaglycosylation may increase the affinity of the antibody for antigen.See, e.g., U.S. Pat. Nos. 5,714,350 and 6,350,861.

Additionally or alternatively, an antibody may be made that has analtered type of glycosylation, such as a hypofucosylated antibody havingreduced amounts of fucosyl residues or an antibody having increasedbisecting GlcNac structures. Such carbohydrate modifications may beaccomplished by, for example, expressing the antibody in a host cellwith altered glycosylation machinery. Cells with altered glycosylationmachinery have been described in the art and may be used as host cellsin which to express recombinant antibodies of the invention to therebyproduce an antibody with altered glycosylation. See U.S. PatentApplication Publication No. 2004/0110704 and Yamane-Ohnuki, et al.(2004) Biotechnol Bioeng. 87: 614-22; EP 1,176,195; WO 2003/035835;Shields, et al. (2002) J. Biol. Chem. 277: 26733-26740; WO 99/54342;Umana, et al. (1999) Nat. Biotech. 17: 176-180; and Tarentino, et al.(1975) Biochem. 14: 5516-23.

An antibody may be pegylated to, for example, increase the biological(e.g., serum) half life of the antibody. To pegylate an antibody, theantibody, or fragment thereof, typically is reacted with polyethyleneglycol (PEG), such as a reactive ester or aldehyde derivative of PEG,under conditions in which at least one PEG groups become attached to theantibody or antibody fragment. Preferably, the pegylation is carried outvia an acylation reaction or an alkylation reaction with a reactive PEGmolecule (or an analogous reactive water-soluble polymer).

The invention also provides variants and equivalents that aresubstantially homologous to the antibodies, antibody fragments,diabodies, SMIPs, camelbodies, nanobodies, IgNAR, polypeptides, variableregions and CDRs set forth herein. These may contain, e.g., conservativesubstitution mutations, (i.e., the substitution of at least one aminoacids by similar amino acids). For example, conservative substitutionrefers to the substitution of an amino acid with another within the samegeneral class, e.g., one acidic amino acid with another acidic aminoacid, one basic amino acid with another basic amino acid, or one neutralamino acid by another neutral amino acid. In another embodiment, theinvention further contemplates the above-recited polypeptide homologs ofthe antibody fragments, variable regions and CDRs set forth hereinfurther having anti-IL-6 activity. Non-limiting examples of anti-IL-6activity are set forth herein, for example, under the heading “Anti-IL-6Activity,” infra.

Anti-IL-6 antibodies have also been disclosed in the following publishedand unpublished patent applications, which are co-owned by the assigneeof the present application: WO 2008/144763; U.S. Patent ApplicationPublication Nos. 2009/0028784, 2009/0297513, and 2009/0297436. Otheranti-IL-6 antibodies have been disclosed in the following U.S. Pat. Nos.7,482,436; 7,291,721; 6,121,423; U.S. Patent Application PublicationNos. 2008/0075726; 2007/0178098; 2007/0154481; 2006/0257407; and2006/0188502.

Polypeptide Sequence Variants

For any anti-IL-6 antibodies sequence described herein, furthercharacterization or optimization may be achieved by systematicallyeither adding or removing amino acid residues to generate longer orshorter peptides, and testing those and sequences generated by walking awindow of the longer or shorter size up or down the antigen from thatpoint. Coupling this approach to generating new candidate targets withtesting for effectiveness of antigenic molecules based on thosesequences in an immunogenicity assay, as known in the art or asdescribed herein, may lead to further manipulation of the antigen.Further still, such optimized sequences may be adjusted by, e.g., theaddition, deletions, or other mutations as known in the art and/ordiscussed herein to further optimize the anti-IL-6 antibodies (e.g.,increasing serum stability or circulating half-life, increasing thermalstability, enhancing delivery, enhance immunogenicity, increasingsolubility, targeting to a particular in vivo location or cell type).

In another embodiment, the invention contemplates polypeptide sequenceshaving at least about 90% sequence homology to any at least one of thepolypeptide sequences of antibody fragments, variable regions and CDRsset forth herein. More preferably, the invention contemplatespolypeptide sequences having at least about 95% sequence homology, evenmore preferably at least about 98% sequence homology, and still morepreferably at least about 99% sequence homology to any at least one ofthe polypeptide sequences of antibody fragments, variable regions andCDRs set forth herein. Methods for determining homology between nucleicacid and amino acid sequences are well known to those of ordinary skillin the art.

The anti-IL-6 antibodies polypeptides described herein may compriseconservative substitution mutations, (i.e., the substitution of at leastone amino acids by similar amino acids). For example, conservativesubstitution refers to the substitution of an amino acid with anotherwithin the same general class, e.g., one acidic amino acid with anotheracidic amino acid, one basic amino acid with another basic amino acid,or one neutral amino acid by another neutral amino acid.

Anti-IL-6 antibodies polypeptide sequences may have at least about 60,65, 70, 75, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94,95, 96, 97, 98, 98.5, 99, 99.5, 99.8, 99.9, or 100% sequence homology toany at least one of the polypeptide sequences set forth herein. Morepreferably, the invention contemplates polypeptide sequences having atleast about 95% sequence homology, even more preferably at least about98% sequence homology, and still more preferably at least about 99%sequence homology to any at least one of the polypeptide sequences ofAnti-IL-6 antibodies polypeptide sequences set forth herein. Methods fordetermining homology between amino acid sequences, as well as nucleicacid sequences, are well known to those of ordinary skill in the art.See, e.g., Nedelkov & Nelson (2006) New and Emerging ProteomicTechniques Humana Press. Thus, an anti-IL-6 antibodies polypeptide mayhave at least about 60, 65, 70, 75, 80, 81, 82, 83, 84, 85, 86, 87, 88,89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 98.5, 99, 99.5, 99.8, 99.9, or100% sequence homology with a polypeptide sequence.

The term homology, or identity, is understood as meaning the number ofagreeing amino acids (identity) with other proteins, expressed inpercent. The identity is preferably determined by comparing a givensequence with other proteins with the aid of computer programs. Ifsequences which are compared with each other are different in length,the identity is to be determined in such a way that the number of aminoacids which the short sequence shares with the longer sequencedetermines the percentage identity. The identity can be determinedroutinely by means of known computer programs which are publiclyavailable such as, for example, Clustal W. Thompson, et al. (1994)Nucleic Acids Research 22: 4673-4680. ClustalW is publicly availablefrom the European Molecular Biology Laboratory and may be downloadedfrom various internet pages, inter alia the IGBMC (Institut de Génétiqueet de Biologie Moléculaire et Cellulaire) and the EBI and all mirroredEBI internet pages (European Bioinformatics Institute). If the ClustalWcomputer program Version 1.8 is used to determine the identity between,for example, the reference protein of the present application and otherproteins, the following parameters are to be set: KTUPLE=1, TOPDIAG=5,WINDOW=5, PAIRGAP=3, GAPOPEN=10, GAPEXTEND=0.05, GAPDIST=8, MAXDIV=40,MATRIX=GONNET, ENDGAPS(OFF), NOPGAP, NOHGAP. See also EuropeanBioinformatics Institute (EBI) toolbox available on-line and Smith(2002) Protein Sequencing Protocols [2^(nd) Ed.] Humana Press.

One possibility of finding similar sequences is to carry out sequencedatabase researches. Here, at least one sequences may be entered as whatis known as a query. This query sequence is then compared with sequencespresent in the selected databases using statistical computer programs.Such database queries (blast searches) are known to the skilled workerand may be carried out at different suppliers. If, for example, such adatabase query is carried out at the NCBI (National Center forBiotechnology Information), the standard settings for the respectivecomparison query should be used. For protein sequence comparisons(blastp), these settings are: Limit entrez=not activated; Filter=lowcomplexity activated; Expect value=10; word size=3; Matrix=BLOSUM62; Gapcosts: Existence=11, Extension=1. The result of such a query is, amongother parameters, the degree of identity between the query sequence andthe similar sequences found in the databases. Methods and materials formaking fragments of Anti-IL-6 antibodies polypeptides are well known inthe art. See, e.g., Maniatis, et al. (2001) Molecular Cloning: ALaboratory Manual [3^(rd) Ed.] Cold Spring Harbor Laboratory Press.

Variant anti-IL-6 antibodies polypeptides may retain their antigenicspecificity to bind IL-6. Fully specific variants may contain onlyconservative variations or variations in non-critical residues or innon-critical regions. Variants may also contain substitution of similaramino acids that result in no change or an insignificant change in theirspecificity. Alternatively, such substitutions may positively ornegatively affect specificity to some degree. Non-specific variantstypically contain at least one non-conservative amino acidsubstitutions, deletions, insertions, inversions, or truncation or asubstitution, insertion, inversion, or deletion in a critical residue orcritical region of an epitope. Molecular biology and biochemistrytechniques for modifying anti-IL-6 antibodies polypeptides whilepreserving specificity are well known in the art. See, e.g., Ho, et al.(1989) Gene 77(1): 51-59; Landt, et al. (1990) Gene 96(1): 125-128; Hopp& Woods (1991) Proc. Natl. Acad. Sci. USA 78(6): 3824-3828; Kolaskar &Tongaonkar (1990) FEBS Letters 276(1-2): 172-174; and Welling, et al.(1985) FEBS Letters 188(2): 215-218.

Amino acids that are essential for function may be identified by methodsknown in the art, such as site-directed mutagenesis or alanine-scanningmutagenesis. Cunningham, et al. (1989) Sci. 244: 1081-85. The latterprocedure introduces single alanine mutations at every residue in themolecule. The resulting mutant molecules are then tested for biologicalactivity such as epitope binding. Sites that are critical forligand-receptor binding may also be determined by structural analysissuch as crystallography, nuclear magnetic resonance, or photoaffinitylabeling. Smith, et al. (1992) J. Mol. Biol. 224: 899-904; de Vos, etal. (1992) Sci. 255: 306-12.

For example, one class of substitutions is conserved amino acidsubstitutions. Such substitutions are those that substitute a givenamino acid in a Anti-IL-6 antibodies polypeptide with another amino acidof like characteristics. Typically seen as conservative substitutionsare the replacements, one for another, among the aliphatic amino acidsAla, Val, Leu, and Ile; interchange of the hydroxyl residues Ser andThr, exchange of the acidic residues Asp and Glu, substitution betweenthe amide residues Asn and Gln, exchange of the basic residues Lys andArg, replacements among the aromatic residues Phe, Tyr. Guidanceconcerning which amino acid changes are likely to be phenotypicallysilent is found in, for example, Bowie, et al. (1990) Sci. 247: 1306-10.Hence, one of ordinary skill in the art appreciates that the inventorspossess peptide variants without delineation of all the specificvariants. As to amino acid sequences, one of skill will recognize thatindividual substitutions, deletions or additions to a nucleic acid,peptide, polypeptide, or protein sequence which alters, adds or deletesa single amino acid or a small percentage of amino acids in the encodedsequence is a “conservatively modified variant” where the alterationresults in the substitution of an amino acid with a chemically similaramino acid. Conservative substitution tables providing functionallysimilar amino acids are well known in the art. Such conservativelymodified variants are in addition to and do not exclude polymorphicvariants, interspecies homologs, and alleles of the invention. See,e.g., Creighton (1992) Proteins: Structures and Molecular Properties[2^(nd) Ed.] W.H. Freeman.

Moreover, polypeptides often contain amino acids other than the twenty“naturally occurring” amino acids. Further, many amino acids, includingthe terminal amino acids, may be modified by natural processes, such asprocessing and other post-translational modifications, or by chemicalmodification techniques well known in the art. Known modificationsinclude, but are not limited to, acetylation, acylation,ADP-ribosylation, amidation, covalent attachment of flavin, covalentattachment of a heme moiety, covalent attachment of a nucleotide ornucleotide derivative, covalent attachment of a lipid or lipidderivative, covalent attachment of phosphotidylinositol, cross-linking,cyclization, disulfide bond formation, demethylation, formation ofcovalent crosslinks, formation of cystine, formation of pyroglutamate,formylation, g-carboxylation, glycosylation, GPI anchor formation,hydroxylation, iodination, methylation, myristoylation, oxidation,proteolytic processing, phosphorylation, prenylation, racemization,selenoylation, sulfation, transfer-RNA mediated addition of amino acidsto proteins such as arginylation, and ubiquitination. See Creighton(1992) Proteins: Structure and Molecular Properties [2^(nd) Ed.] andLundblad (1995) Techniques in Protein Modification [1^(st) Ed.] Manydetailed reviews are available on this subject. See, e.g., Wold (1983)Posttranslational Covalent Modification of Proteins Acad. Press, NY;Seifter, et al. (1990) Meth. Enzymol. 182: 626-46; and Rattan, et al.(1992) Ann. NY Acad. Sci. 663: 48-62.

In another embodiment, the invention further contemplates the generationand use of anti-idiotypic antibodies that bind any of the foregoingsequences. In an exemplary embodiment, such an anti-idiotypic antibodycould be administered to a subject who has received an anti-IL-6antibody to modulate, reduce, or neutralize, the effect of the anti-IL-6antibody. A further exemplary use of such anti-idiotypic antibodies isfor detection of the anti-IL-6 antibodies of the present invention, forexample to monitor the levels of the anti-IL-6 antibodies present in asubject's blood or other bodily fluids.

The present invention also contemplates anti-IL-6 antibodies comprisingany of the polypeptide or polynucleotide sequences described hereinsubstituted for any of the other polynucleotide sequences describedherein. For example, without limitation thereto, the present inventioncontemplates antibodies comprising the combination of any of thevariable light chain and variable heavy chain sequences describedherein, and further contemplates antibodies resulting from substitutionof any of the CDR sequences described herein for any of the other CDRsequences described herein. As noted preferred anti-IL-6 antibodies orfragments or variants thereof may contain a variable heavy and/or lightsequence as shown in FIG. 2-5, such as SEQ ID NO: 651, 657, 709 orvariants thereof wherein at least one CDR or FR residues are modifiedwithout adversely affecting antibody binding to IL-6 or other desiredfunctional activity.

Polynucleotides Encoding Anti-IL-6 Antibody Polypeptides

The invention is further directed to polynucleotides encodingpolypeptides of the antibodies having binding specificity to IL-6. Inone embodiment of the invention, polynucleotides of the inventioncomprise, or alternatively consist of, the following polynucleotidesequence encoding the variable light chain polypeptide sequence of SEQID NO: 2 which is encoded by the polynucleotide sequence of SEQ ID NO:10 or the polynucleotide sequence of SEQ ID NO: 662, 698, 701, or 705.

In another embodiment of the invention, polynucleotides of the inventioncomprise, or alternatively consist of, the following polynucleotidesequence encoding the variable heavy chain polypeptide sequence of SEQID NO: 3 which is encoded by the polynucleotide sequence of SEQ ID NO:11 or the polynucleotide sequence of SEQ ID NO: 663, 700, 703, or 707.

In a further embodiment of the invention, polynucleotides encodingfragments or variants of the antibody having binding specificity to IL-6comprise, or alternatively consist of, at least one of thepolynucleotide sequences of SEQ ID NO: 12 or 694; SEQ ID NO: 13; and SEQID NO: 14 or 695 which correspond to polynucleotides encoding thecomplementarity-determining regions (CDRs, or hypervariable regions) ofthe light chain variable sequence of SEQ ID NO: 2.

In a further embodiment of the invention, polynucleotides encodingfragments or variants of the antibody having binding specificity to IL-6comprise, or alternatively consist of, at least one of thepolynucleotide sequences of SEQ ID NO: 15; SEQ ID NO: 16 or 696; and SEQID NO: 17 or 697 which correspond to polynucleotides encoding thecomplementarity-determining regions (CDRs, or hypervariable regions) ofthe heavy chain variable sequence of SEQ ID NO: 3 or SEQ ID NO: 661 orSEQ ID NO: 657 or others depicted in FIG. 4 or 5.

The invention also contemplates polynucleotide sequences including atleast one of the polynucleotide sequences encoding antibody fragments orvariants described herein. In one embodiment of the invention,polynucleotides encoding fragments or variants of the antibody havingbinding specificity to IL-6 comprise, or alternatively consist of, one,two, three or more, including all of the following polynucleotidesencoding antibody fragments: the polynucleotide SEQ ID NO: 10 encodingthe light chain variable region of SEQ ID NO: 2; the polynucleotide SEQID NO: 11 encoding the heavy chain variable region of SEQ ID NO: 3; thepolynucleotide SEQ ID NO: 720 encoding the light chain polypeptide ofSEQ ID NO: 20; the polynucleotide SEQ ID NO: 721 encoding the lightchain polypeptide of SEQ ID NO: 647; the polynucleotide SEQ ID NO: 662encoding the light chain polypeptide of SEQ ID NO: 660; thepolynucleotide SEQ ID NO: 722 encoding the light chain polypeptide ofSEQ ID NO: 666; the polynucleotide SEQ ID NO: 698 encoding the lightchain polypeptide of SEQ ID NO: 699; the polynucleotide SEQ ID NO: 701encoding the light chain polypeptide of SEQ ID NO: 702; thepolynucleotide SEQ ID NO: 705 encoding the light chain polypeptide ofSEQ ID NO: 706; the polynucleotide SEQ ID NO: 723 encoding the lightchain polypeptide of SEQ ID NO: 709; the polynucleotide SEQ ID NO: 724encoding the heavy chain polypeptide of SEQ ID NO: 19; thepolynucleotide SEQ ID NO: 725 encoding the heavy chain polypeptide ofSEQ ID NO: 652; the polynucleotide SEQ ID NO: 700 encoding the heavychain polypeptide of SEQ ID NO: 657; the polynucleotide SEQ ID NO: 663encoding the heavy chain polypeptide of SEQ ID NO: 661; thepolynucleotide SEQ ID NO: 703 encoding the heavy chain polypeptide ofSEQ ID NO: 704; the polynucleotide SEQ ID NO: 707 encoding the heavychain polypeptide of SEQ ID NO: 708; the polynucleotides of SEQ ID NO:12, 13, 14, 694 and 695 encoding the complementarity-determining regionsof the aforementioned light chain polypeptides; and the polynucleotidesof SEQ ID NO: 15, 16, 17, 696 and 697 encoding thecomplementarity-determining regions of the aforementioned heavy chainpolypeptides, and polynucleotides encoding the variable heavy and lightchain sequences in SEQ ID NO: 657 and SEQ ID NO: 709 respectively, e.g.,the nucleic acid sequences in SEQ ID NO: 700 and SEQ ID NO: 723 andfragments or variants thereof, e.g., based on codon degeneracy. Thesenucleic acid sequences encoding variable heavy and light chain sequencesmay be expressed alone or in combination and these sequences preferablyare fused to suitable variable constant sequences, e.g., those in SEQ IDNO: 589 and SEQ ID NO: 587.

Exemplary nucleotide sequences encoding anti-IL-6 antibodies of thepresent invention are identified in Table 4. The polynucleotidesequences shown are to be understood to be illustrative, rather thanlimiting. One of skill in the art can readily determine thepolynucleotide sequences that would encode a given polypeptide and canreadily generate coding sequences suitable for expression in a givenexpression system, such as by adapting the polynucleotide sequencesprovided and/or by generating them de novo, and can readily producecodon-optimized expression sequences, for example as described inpublished U.S. Patent Application No. 2008/0120732 or using othermethods known in the art.

In another embodiment of the invention, polynucleotides of the inventionfurther comprise, the following polynucleotide sequence encoding thekappa constant light chain sequence of SEQ ID NO: 586 which is encodedby the polynucleotide sequence of SEQ ID NO: 587.

In another embodiment of the invention, polynucleotides of the inventionfurther comprise, the following polynucleotide sequence encoding thegamma-1 constant heavy chain polypeptide sequence of SEQ ID NO: 588which is encoded by the polynucleotide sequence of SEQ ID NO: 589.

In one embodiment, the invention is directed to an isolatedpolynucleotide comprising a polynucleotide encoding an anti-IL-6 V_(H)antibody amino acid sequence selected from SEQ ID NO: 3, 18, 19, 652,656, 657, 658, 661, 664, 665, 704, and 708 or encoding a variant thereofwherein at least one framework residue (FR residue) has been substitutedwith an amino acid present at the corresponding position in a rabbitanti-IL-6 antibody V_(H) polypeptide or a conservative amino acidsubstitution. In addition, the invention specifically encompasseshumanized anti-IL-6 antibodies or humanized antibody binding fragmentsor variants thereof and nucleic acid sequences encoding the foregoingcomprising the humanized variable heavy chain and/or light chainpolypeptides depicted in the sequences contained in FIG. 1-5, or thoseidentified in Table 4, or variants thereof wherein at least oneframework or CDR residues may be modified. Preferably, if anymodifications are introduced they will not affect adversely the bindingaffinity of the resulting anti-IL-6 antibody or fragment or variantthereof.

In another embodiment, the invention is directed to an isolatedpolynucleotide comprising the polynucleotide sequence encoding ananti-IL-6 V_(L) antibody amino acid sequence selected from SEQ ID NO: 2,20, 647, 651, 660, 666, 699, 702, 706, and 709 or encoding a variantthereof wherein at least one framework residue (FR residue) has beensubstituted with an amino acid present at the corresponding position ina rabbit anti-IL-6 antibody V_(L) polypeptide or a conservative aminoacid substitution.

In yet another embodiment, the invention is directed to at least oneheterologous polynucleotides comprising a sequence encoding thepolypeptides set forth in SEQ ID NO: 2 and SEQ ID NO: 3; SEQ ID NO: 2and SEQ ID NO: 18; SEQ ID NO: 2 and SEQ ID NO: 19; SEQ ID NO: 20 and SEQID NO: 3; SEQ ID NO: 20 and SEQ ID NO: 18; or SEQ ID NO: 20 and SEQ IDNO: 19.

In another embodiment, the invention is directed to an isolatedpolynucleotide that expresses a polypeptide containing at least one CDRpolypeptide derived from an anti-IL-6 antibody wherein said expressedpolypeptide alone specifically binds IL-6 or specifically binds IL-6when expressed in association with another polynucleotide sequence thatexpresses a polypeptide containing at least one CDR polypeptide derivedfrom an anti-IL-6 antibody wherein said at least one CDR is selectedfrom those contained in the V_(L) or V_(H) polypeptides set forth in SEQID NO: 3, 18, 19, 652, 656, 657, 658, 661, 664, 665, 704, 708, 2, 20,647, 651, 660, 666, 699, 702, 706, or 709.

Host cells and vectors comprising said polynucleotides are alsocontemplated.

In another specific embodiment the invention covers nucleic acidconstructs containing any of the foregoing nucleic acid sequences andcombinations thereof as well as recombinant cells containing thesenucleic acid sequences and constructs containing wherein these nucleicacid sequences or constructs may be extrachromosomal or integrated intothe host cell genome.

The invention further contemplates vectors comprising the polynucleotidesequences encoding the variable heavy and light chain polypeptidesequences, as well as the individual complementarity determining regions(CDRs, or hypervariable regions) set forth herein, as well as host cellscomprising said sequences. In one embodiment of the invention, the hostcell is a yeast cell. In another embodiment of the invention, the yeasthost cell belongs to the genus Pichia.

In some instances, more than one exemplary polynucleotide encoding agiven polypeptide sequence is provided, as summarized in Table 2.

TABLE 2 Multiple exemplary polynucleotides encoding particularpolypeptides. Polypeptide Exemplary coding SEQ ID NO SEQ ID NOs 4 12,111, 694 5 13, 112, 389, 501 6 14, 113, 695 9 17, 116, 697 39 47, 260 4048, 261 60 68, 265 72 80, 325, 565, 581 89 97, 134, 166 103 12, 111, 694104 13, 112, 389, 501 105 14, 113, 695 108 17, 116, 697 126 97, 134, 166158 97, 134, 166 190 198, 214 191 199, 215 205 213, 469, 485 206 198,214 207 199, 215 252 47, 260 253 48, 261 257 68, 265 317 80, 325, 565,581 333 341, 533 381 13, 112, 389, 501 415 423, 439 431 423, 439 461213, 469, 485 475 483, 499 476 484, 500 477 213, 469, 485 478 486, 502479 487, 503 480 488, 504 481 489, 505 491 483, 499 492 484, 500 493 13,112, 389, 501 494 486, 502 495 487, 503 496 488, 504 497 489, 505 525341, 533 545 553, 585 554 562, 578 556 564, 580 557 80, 325, 565, 581558 566, 582 570 562, 578 572 564, 580 573 80, 325, 565, 581 574 566,582 577 553, 585

In some instances, multiple sequence identifiers refer to the samepolypeptide or polynucleotide sequence, as summarized in Table 3.References to these sequence identifiers are understood to beinterchangeable, except where context indicates otherwise.

TABLE 3 Repeated sequences. Each cell lists a group of repeatedsequences included in the sequence listing. SEQ ID NOs of repeatedsequences 4, 103 5, 104, 381, 493 6, 105 9, 108 12, 111 13, 112 14, 11317, 116 39, 252 40, 253 48, 261 60, 257 68, 265 72, 317, 557, 573 80,325, 565, 581 89, 126, 158 97, 134, 166 120, 659 190, 206 191, 207 198,214 199, 215 205, 461, 477 213, 469 333, 525 415, 431 423, 439 475, 491476, 492 478, 494 479, 495 480, 496 481, 497 483, 499 484, 500 486, 502487, 503 488, 504 489, 505 545, 577 554, 570 556, 572 558, 574 562, 578564, 580 566, 582

Certain exemplary embodiments include polynucleotides that hybridizeunder moderately or highly stringent hybridization conditions to apolynucleotide having one of the exemplary coding sequences recited inTable 4, and also include polynucleotides that hybridize undermoderately or highly stringent hybridization conditions to apolynucleotide encoding the same polypeptide as a polynucleotide havingone of the exemplary coding sequences recited in Table 4, or polypeptideencoded by any of the foregoing polynucleotides.

The phrase “high stringency hybridization conditions” refers toconditions under which a probe will hybridize to its target subsequence,typically in a complex mixture of nucleic acid, but to no othersequences. High stringency conditions are sequence dependent and will bedifferent in different circumstances. Longer sequences hybridizespecifically at higher temperatures. An extensive guide to thehybridization of nucleic acids is found in Tijssen, Techniques inBiochemistry and Molecular Biology—Hybridization with Nucleic Probes,“Overview of principles of hybridization and the strategy of nucleicacid assays” (1993). Generally, high stringency conditions are selectedto be about 5-10° C. lower than the thermal melting point (T_(m)) forthe specific sequence at a defined ionic strength pH. The T_(m) is thetemperature (under defined ionic strength, pH, and nucleicconcentration) at which 50% of the probes complementary to the targethybridize to the target sequence at equilibrium (as the target sequencesare present in excess, at T_(m), 50% of the probes are occupied atequilibrium). High stringency conditions will be those in which the saltconcentration is less than about 1.0 M sodium ion, typically about 0.01to 1.0 M sodium ion concentration (or other salts) at pH 7.0 to 8.3 andthe temperature is at least about 30° C. for short probes (e.g., 10 to50 nucleotides) and at least about 60° C. for long probes (e.g., greaterthan 50 nucleotides). High stringency conditions may also be achievedwith the addition of destabilizing agents such as formamide. Forselective or specific hybridization, a positive signal is at least twotimes background, optionally 10 times background hybridization.Exemplary high stringency hybridization conditions can be as following:50% formamide, 5×SSC, and 1% SDS, incubating at 42° C., or, 5×SSC, 1%SDS, incubating at 65° C., with wash in 0.2×SSC, and 0.1% SDS at 65° C.Such hybridizations and wash steps can be carried out for, e.g., 1, 2,5, 10, 15, 30, 60; or more minutes.

Nucleic acids that do not hybridize to each other under high stringencyconditions are still substantially related if the polypeptides that theyencode are substantially related. This occurs, for example, when a copyof a nucleic acid is created using the maximum codon degeneracypermitted by the genetic code. In such cases, the nucleic acidstypically hybridize under moderate stringency hybridization conditions.Exemplary “moderate stringency hybridization conditions” include ahybridization in a buffer of 40% formamide, 1 M NaCl, 1% SDS at 37° C.,and a wash in 1×SSC at 45° C. Such hybridizations and wash steps can becarried out for, e.g., 1, 2, 5, 10, 15, 30, 60, or more minutes. Apositive hybridization is at least twice background. Those of ordinaryskill will readily recognize that alternative hybridization and washconditions can be utilized to provide conditions of similar stringency.

Expression vectors for use in the methods of the invention will furtherinclude yeast specific sequences, including a selectable auxotrophic ordrug marker for identifying transformed yeast strains. A drug marker mayfurther be used to amplify copy number of the vector in a yeast hostcell.

The polypeptide coding sequence of interest is operably linked totranscriptional and translational regulatory sequences that provide forexpression of the polypeptide in yeast cells. These vector componentsmay include, but are not limited to, at least one of the following: anenhancer element, a promoter, and a transcription termination sequence.Sequences for the secretion of the polypeptide may also be included,e.g. a signal sequence. A yeast origin of replication is optional, asexpression vectors are often integrated into the yeast genome.

In one embodiment of the invention, the polypeptide of interest isoperably linked, or fused, to sequences providing for optimizedsecretion of the polypeptide from yeast diploid cells.

Nucleic acids are “operably linked” when placed into a functionalrelationship with another nucleic acid sequence. For example, DNA for asignal sequence is operably linked to DNA for a polypeptide if it isexpressed as a preprotein that participates in the secretion of thepolypeptide; a promoter or enhancer is operably linked to a codingsequence if it affects the transcription of the sequence. Generally,“operably linked” means that the DNA sequences being linked arecontiguous, and, in the case of a secretory leader, contiguous and inreading frame. However, enhancers do not have to be contiguous. Linkingis accomplished by ligation at convenient restriction sites oralternatively via a PCR/recombination method familiar to those skilledin the art (Gateway® Technology; Invitrogen, Carlsbad Calif.). If suchsites do not exist, the synthetic oligonucleotide adapters or linkersare used in accordance with conventional practice.

Promoters are untranslated sequences located upstream (5′) to the startcodon of a structural gene (generally within about 100 to 1000 bp) thatcontrol the transcription and translation of particular nucleic acidsequences to which they are operably linked. Such promoters fall intoseveral classes: inducible, constitutive, and repressible promoters(that increase levels of transcription in response to absence of arepressor). Inducible promoters may initiate increased levels oftranscription from DNA under their control in response to some change inculture conditions, e.g., the presence or absence of a nutrient or achange in temperature.

The yeast promoter fragment may also serve as the site for homologousrecombination and integration of the expression vector into the samesite in the yeast genome; alternatively a selectable marker is used asthe site for homologous recombination. Pichia transformation isdescribed in Cregg, et al. (1985) Mol. Cell. Biol. 5:3376-3385.

Examples of suitable promoters from Pichia include the AOX1 and promoter(Cregg, et al. (1989) Mol. Cell. Biol. 9:1316-1323); ICL1 promoter(Menendez, et al. (2003) Yeast 20(13):1097-108);glyceraldehyde-3-phosphate dehydrogenase promoter (GAP) (Waterham, etal. (1997) Gene 186(1):37-44); and FLD1 promoter (Shen, et al. (1998)Gene 216(1):93-102). The GAP promoter is a strong constitutive promoterand the AOX and FLD 1 promoters are inducible.

Other yeast promoters include ADH1, alcohol dehydrogenase II, GAL4,PHO3, PHO5, Pyk, and chimeric promoters derived therefrom. Additionally,non-yeast promoters may be used in the invention such as mammalian,insect, plant, reptile, amphibian, viral, and avian promoters. Mosttypically the promoter will comprise a mammalian promoter (potentiallyendogenous to the expressed genes) or will comprise a yeast or viralpromoter that provides for efficient transcription in yeast systems.

The polypeptides of interest may be produced recombinantly not onlydirectly, but also as a fusion polypeptide with a heterologouspolypeptide, e.g. a signal sequence or other polypeptide having aspecific cleavage site at the N-terminus of the mature protein orpolypeptide. In general, the signal sequence may be a component of thevector, or it may be a part of the polypeptide coding sequence that isinserted into the vector. The heterologous signal sequence selectedpreferably is one that is recognized and processed through one of thestandard pathways available within the host cell. The S. cerevisiaealpha factor pre-pro signal has proven effective in the secretion of avariety of recombinant proteins from P. pastoris. Other yeast signalsequences include the alpha mating factor signal sequence, the invertasesignal sequence, and signal sequences derived from other secreted yeastpolypeptides. Additionally, these signal peptide sequences may beengineered to provide for enhanced secretion in diploid yeast expressionsystems. Other secretion signals of interest also include mammaliansignal sequences, which may be heterologous to the protein beingsecreted, or may be a native sequence for the protein being secreted.Signal sequences include pre-peptide sequences, and in some instancesmay include propeptide sequences. Many such signal sequences are knownin the art, including the signal sequences found on immunoglobulinchains, e.g., K28 preprotoxin sequence, PHA-E, FACE, human MCP-1, humanserum albumin signal sequences, human Ig heavy chain, human Ig lightchain, and the like. See Hashimoto, et al. (1998) Protein Eng 11(2): 75;and Kobayashi, et al. (1998) Therapeutic Apheresis 2(4): 257.

Transcription may be increased by inserting a transcriptional activatorsequence into the vector. These activators are cis-acting elements ofDNA, usually about from 10 to 300 bp, which act on a promoter toincrease its transcription. Transcriptional enhancers are relativelyorientation and position independent, having been found 5′ and 3′ to thetranscription unit, within an intron, as well as within the codingsequence itself. The enhancer may be spliced into the expression vectorat a position 5′ or 3′ to the coding sequence, but is preferably locatedat a site 5′ from the promoter.

Expression vectors used in eukaryotic host cells may also containsequences necessary for the termination of transcription and forstabilizing the mRNA. Such sequences are commonly available from 3′ tothe translation termination codon, in untranslated regions of eukaryoticor viral DNAs or cDNAs. These regions contain nucleotide segmentstranscribed as polyadenylated fragments in the untranslated portion ofthe mRNA.

Construction of suitable vectors containing at least one of theabove-listed components employs standard ligation techniques orPCR/recombination methods. Isolated plasmids or DNA fragments arecleaved, tailored, and re-ligated in the form desired to generate theplasmids required or via recombination methods. For analysis to confirmcorrect sequences in plasmids constructed, the ligation mixtures areused to transform host cells, and successful transformants selected byantibiotic resistance (e.g. ampicillin or Zeocin® (phleomycin)) whereappropriate. Plasmids from the transformants are prepared, analyzed byrestriction endonuclease digestion and/or sequenced.

As an alternative to restriction and ligation of fragments,recombination methods based on att sites and recombination enzymes maybe used to insert DNA sequences into a vector. Such methods aredescribed, for example, by Landy (1989) Ann. Rev. Biochem. 58: 913-949;and are known to those of skill in the art. Such methods utilizeintermolecular DNA recombination that is mediated by a mixture of lambdaand E. coli-encoded recombination proteins. Recombination occurs betweenspecific attachment (att) sites on the interacting DNA molecules. For adescription of att sites See Weisberg and Landy (1983) Site-SpecificRecombination in Phage Lambda Cold Spring Harbor, N.Y.:Cold SpringHarbor Press), pages 211-250. The DNA segments flanking therecombination sites are switched, such that after recombination, the attsites are hybrid sequences comprised of sequences donated by eachparental vector. The recombination can occur between DNAs of anytopology.

Att sites may be introduced into a sequence of interest by ligating thesequence of interest into an appropriate vector; generating a PCRproduct containing att B sites through the use of specific primers;generating a cDNA library cloned into an appropriate vector containingatt sites.

The expression host may be further modified by the introduction ofsequences encoding at least one enzymes that enhance folding anddisulfide bond formation, i.e. foldases, chaperonins, Such sequences maybe constitutively or inducibly expressed in the yeast host cell, usingvectors, markers, are known in the art. Preferably the sequences,including transcriptional regulatory elements sufficient for the desiredpattern of expression, are stably integrated in the yeast genome througha targeted methodology.

For example, the eukaryotic PDI is not only an efficient catalyst ofprotein cysteine oxidation and disulfide bond isomerization, but alsoexhibits chaperone activity. Co-expression of PDI can facilitate theproduction of active proteins having multiple disulfide bonds. Also ofinterest is the expression of BIP (immunoglobulin heavy chain bindingprotein); cyclophilin; and the like. In one embodiment of the invention,each of the haploid parental strains expresses a distinct foldingenzyme, e.g. one strain may express BIP, and the other strain mayexpress PDI or combinations thereof.

Vectors are used to introduce a foreign substance, such as DNA, RNA orprotein, into an organism or host cell. Typical vectors includerecombinant viruses (for polynucleotides) and liposomes or other lipidaggregates (for polypeptides and/or polynucleotides). A “DNA vector” isa replicon, such as plasmid, phage or cosmid, to which anotherpolynucleotide segment may be attached so as to bring about thereplication of the attached segment. An “expression vector” is a DNAvector which contains regulatory sequences which will direct polypeptidesynthesis by an appropriate host cell. This usually means a promoter tobind RNA polymerase and initiate transcription of mRNA, as well asribosome binding sites and initiation signals to direct translation ofthe mRNA into a polypeptide(s). Incorporation of a polynucleotidesequence into an expression vector at the proper site and in correctreading frame, followed by transformation of an appropriate host cell bythe vector, enables the production of a polypeptide encoded by saidpolynucleotide sequence. Exemplary expression vectors and techniques fortheir use are described in the following publications: Old, et al.(1989) Principles of Gene Manipulation: An Introduction to GeneticEngineering, Blackwell Scientific Publications [4^(th) Ed.]; Sambrook,et al. (1989) Molecular Cloning: A Laboratory Manual, 2nd Edition, ColdSpring Harbor Laboratory Press; Sambrook, et al. (2001) MolecularCloning: A Laboratory Manual [3^(rd) Ed.] Cold Spring Harbor LaboratoryPress; Gorman, “High Efficiency Gene Transfer into Mammalian Cells,” inDNA Cloning, Volume II, Glover, D. M., Ed., IRL Press, Washington, D.C.,pages 143-190.

For example, a liposomes or other lipid aggregate may comprise a lipidsuch as phosphatidylcholines (lecithins) (PC), phosphatidylethanolamines(PE), lysolecithins, lysophosphatidylethanolamines, phosphatidylserines(PS), phosphatidylglycerols (PG), phosphatidylinositol (PI),sphingomyelins, cardiolipin, phosphatidic acids (PA), fatty acids,gangliosides, glucolipids, glycolipids, mono-, di or triglycerides,ceramides, cerebrosides and combinations thereof; a cationic lipid (orother cationic amphiphile) such as 1,2-dioleyloxy-3-(trimethylamino)propane (DOTAP);N-cholesteryloxycarbaryl-3,7,12-triazapentadecane-1,15-diamine (CTAP);N-[1-(2,3,-ditetradecyloxy)propyl]-N,N-dimethyl-N-hydroxyethylammoniumbromide (DMRIE); N-[1-(2,3,-dioleyloxy)propyl]-N,N-dimethyl-N-hydroxyethylammonium bromide (DORIE);N-[1-(2,3-dioleyloxy)propyl]-N,N,N-trimethylammonium chloride (DOTMA); 3beta [N—(N′,N′-dimethylaminoethane)carbamoly] cholesterol (DC-Choi); anddimethyldioctadecylammonium (DDAB); dioleoylphosphatidyl ethanolamine(DOPE), cholesterol-containing DOPC; and combinations thereof; and/or ahydrophilic polymer such as polyvinylpyrrolidone, polyvinylmethylether,polymethyloxazoline, polyethyloxazoline, polyhydroxypropyloxazoline,polyhydroxypropylmethacrylamide, polymethacrylamide,polydimethylacrylamide, polyhydroxypropylmethacrylate,polyhydroxyethylacrylate, hydroxymethylcellulose, hydroxyethylcellulose,polyethyleneglycol, polyaspartamide and combinations thereof. Othersuitable cationic lipids are described in Miller (1998) AngewandteChemie International Edition 37(13-14): 1768-1785 and Cooper, et al.(1998) Chem. Eur. J. 4(1): 137-151. Liposomes can be crosslinked,partially crosslinked, or free from crosslinking. Crosslinked liposomescan include crosslinked as well as non-crosslinked components. Suitablecationic liposomes or cytofectins are commercially available and canalso be prepared as described in Sipkins, et al. (1998) Nature Medicine4(5): 623-626 or as described in Miller, supra. Exemplary liposomesinclude a polymerizable zwitterionic or neutral lipid, a polymerizableintegrin targeting lipid and a polymerizable cationic lipid suitable forbinding a nucleic acid. Liposomes can optionally include peptides thatprovide increased efficiency, for example as described in U.S. Pat. No.7,297,759. Additional exemplary liposomes and other lipid aggregates aredescribed in U.S. Pat. No. 7,166,298.

Methods of Producing Antibodies and Fragments Thereof.

The invention is also directed to the production of the antibodiesdescribed herein or fragments thereof. Recombinant polypeptidescorresponding to the antibodies described herein or fragments thereofare secreted from polyploidal, preferably diploid or tetraploid strainsof mating competent yeast. In an exemplary embodiment, the invention isdirected to methods for producing these recombinant polypeptides insecreted form for prolonged periods using cultures comprising polyploidyeast, i.e., at least several days to a week, more preferably at least amonth or several months, and even more preferably at least 6 months to ayear or longer. These polyploid yeast cultures will express at least10-25 mg/liter of the polypeptide, more preferably at least 50-250mg/liter, still more preferably at least 500-1000 mg/liter, and mostpreferably a gram per liter or more of the recombinant polypeptide(s).

In one embodiment of the invention a pair of genetically marked yeasthaploid cells are transformed with expression vectors comprisingsubunits of a desired heteromultimeric protein. One haploid cellcomprises a first expression vector, and a second haploid cell comprisesa second expression vector. In another embodiment diploid yeast cellswill be transformed with at least one expression vectors that providefor the expression and secretion of at least one of the recombinantpolypeptides. In still another embodiment a single haploid cell may betransformed with at least one vectors and used to produce a polyploidalyeast by fusion or mating strategies. In yet another embodiment adiploid yeast culture may be transformed with at least one vectorsproviding for the expression and secretion of a desired polypeptide orpolypeptides. These vectors may comprise vectors e.g., linearizedplasmids or other linear DNA products that integrate into the yeastcell's genome randomly, through homologous recombination, or using arecombinase such as Cre/Lox or Flp/Frt. Optionally, additionalexpression vectors may be introduced into the haploid or diploid cells;or the first or second expression vectors may comprise additional codingsequences; for the synthesis of heterotrimers; heterotetramers. Theexpression levels of the non-identical polypeptides may be individuallycalibrated, and adjusted through appropriate selection, vector copynumber, promoter strength and/or induction and the like. The transformedhaploid cells are genetically crossed or fused. The resulting diploid ortetraploid strains are utilized to produce and secrete fully assembledand biologically functional proteins, humanized antibodies describedherein or fragments thereof.

The use of diploid or tetraploid cells for protein production providesfor unexpected benefits. The cells can be grown for production purposes,i.e. scaled up, and for extended periods of time, in conditions that canbe deleterious to the growth of haploid cells, which conditions mayinclude high cell density; growth in minimal media; growth at lowtemperatures; stable growth in the absence of selective pressure; andwhich may provide for maintenance of heterologous gene sequenceintegrity and maintenance of high level expression over time. Withoutwishing to be bound thereby, the inventors theorize that these benefitsmay arise, at least in part, from the creation of diploid strains fromtwo distinct parental haploid strains. Such haploid strains can comprisenumerous minor autotrophic mutations, which mutations are complementedin the diploid or tetraploid, enabling growth and enhanced productionunder highly selective conditions.

Transformed mating competent haploid yeast cells provide a geneticmethod that enables subunit pairing of a desired protein. Haploid yeaststrains are transformed with each of two expression vectors, a firstvector to direct the synthesis of one polypeptide chain and a secondvector to direct the synthesis of a second, non-identical polypeptidechain. The two haploid strains are mated to provide a diploid host whereoptimized target protein production can be obtained.

Optionally, additional non-identical coding sequence(s) are provided.Such sequences may be present on additional expression vectors or in thefirst or the second expression vectors. As is known in the art, multiplecoding sequences may be independently expressed from individualpromoters; or may be coordinately expressed through the inclusion of an“internal ribosome entry site” or “IRES”, which is an element thatpromotes direct internal ribosome entry to the initiation codon, such asATG, of a cistron (a protein encoding region), thereby leading to thecap-independent translation of the gene. IRES elements functional inyeast are described by Thompson, et al. (2001) PNAS 98: 12866-12868.

In one embodiment of the invention, antibody sequences are produced incombination with a secretory J chain, which provides for enhancedstability of IgA. See U.S. Pat. Nos. 5,959,177 and 5,202,422.

In a preferred embodiment the two haploid yeast strains are eachauxotrophic, and require supplementation of media for growth of thehaploid cells. The pair of auxotrophs are complementary, such that thediploid product will grow in the absence of the supplements required forthe haploid cells. Many such genetic markers are known in yeast,including requirements for amino acids (e.g. met, lys, his, arg),nucleosides (e.g. ura3, ade1); and the like. Amino acid markers may bepreferred for the methods of the invention. Alternatively diploid cellswhich contain the desired vectors can be selected by other means, e.g.,by use of other markers, such as green fluorescent protein, antibioticresistance genes, various dominant selectable markers, and the like.

Two transformed haploid cells may be genetically crossed and diploidstrains arising from this mating event selected by their hybridnutritional requirements and/or antibiotic resistance spectra.Alternatively, populations of the two transformed haploid strains arespheroplasted and fused, and diploid progeny regenerated and selected.By either method, diploid strains can be identified and selectivelygrown based on their ability to grow in different media than theirparents. For example, the diploid cells may be grown in minimal mediumthat may include antibiotics. The diploid synthesis strategy has certainadvantages. Diploid strains have the potential to produce enhancedlevels of heterologous protein through broader complementation tounderlying mutations, which may impact the production and/or secretionof recombinant protein. Furthermore, once stable strains have beenobtained, any antibiotics used to select those strains do notnecessarily need to be continuously present in the growth media.

As noted above, in some embodiments a haploid yeast may be transformedwith a single or multiple vectors and mated or fused with anon-transformed cell to produce a diploid cell containing the vector orvectors. In other embodiments, a diploid yeast cell may be transformedwith at least one vectors that provide for the expression and secretionof a desired heterologous polypeptide by the diploid yeast cell.

In one embodiment of the invention, two haploid strains are transformedwith a library of polypeptides, e.g. a library of antibody heavy orlight chains. Transformed haploid cells that synthesize the polypeptidesare mated with the complementary haploid cells. The resulting diploidcells are screened for functional protein. The diploid cells provide ameans of rapidly, conveniently and inexpensively bringing together alarge number of combinations of polypeptides for functional testing.This technology is especially applicable for the generation ofheterodimeric protein products, where optimized subunit synthesis levelsare critical for functional protein expression and secretion.

In another embodiment of the invention, the expression level ratio ofthe two subunits is regulated in order to maximize product generation.Heterodimer subunit protein levels have been shown previously to impactthe final product generation. Simmons (2002) J Immunol Methods.263(1-2): 133-47. Regulation can be achieved prior to the mating step byselection for a marker present on the expression vector. By stablyincreasing the copy number of the vector, the expression level can beincreased. In some cases, it may be desirable to increase the level ofone chain relative to the other, so as to reach a balanced proportionbetween the subunits of the polypeptide. Antibiotic resistance markersare useful for this purpose, e.g. Zeocin® (phleomycin) resistancemarker, G418 resistance and provide a means of enrichment for strainsthat contain multiple integrated copies of an expression vector in astrain by selecting for transformants that are resistant to higherlevels of Zeocin® (phleomycin) or G418. The proper ratio (e.g. 1:1; 1:2)of the subunit genes may be important for efficient protein production.Even when the same promoter is used to transcribe both subunits, manyother factors contribute to the final level of protein expressed andtherefore, it can be useful to increase the number of copies of oneencoded gene relative to the other. Alternatively, diploid strains thatproduce higher levels of a polypeptide, relative to single copy vectorstrains, are created by mating two haploid strains, both of which havemultiple copies of the expression vectors.

Host cells are transformed with the above-described expression vectors,mated to form diploid strains, and cultured in conventional nutrientmedia modified as appropriate for inducing promoters, selectingtransformants or amplifying the genes encoding the desired sequences. Anumber of minimal media suitable for the growth of yeast are known inthe art. Any of these media may be supplemented as necessary with salts(such as sodium chloride, calcium, magnesium, and phosphate), buffers(such as phosphate, HEPES), nucleosides (such as adenosine andthymidine), antibiotics, trace elements, and glucose or an equivalentenergy source. Any other necessary supplements may also be included atappropriate concentrations that would be known to those skilled in theart. The culture conditions, such as temperature, pH and the like, arethose previously used with the host cell selected for expression, andwill be apparent to the ordinarily skilled artisan.

Secreted proteins are recovered from the culture medium. A proteaseinhibitor, such as phenyl methyl sulfonyl fluoride (PMSF) may be usefulto inhibit proteolytic degradation during purification, and antibioticsmay be included to prevent the growth of adventitious contaminants. Thecomposition may be concentrated, filtered, dialyzed, using methods knownin the art.

The diploid cells of the invention are grown for production purposes.Such production purposes desirably include growth in minimal media,which media lacks pre-formed amino acids and other complex biomolecules,e.g., media comprising ammonia as a nitrogen source, and glucose as anenergy and carbon source, and salts as a source of phosphate, calciumand the like. Preferably such production media lacks selective agentssuch as antibiotics, amino acids, purines, pyrimidines The diploid cellscan be grown to high cell density, for example at least about 50 g/L;more usually at least about 100 g/L; and may be at least about 300,about 400, about 500 g/L or more.

In one embodiment of the invention, the growth of the subject cells forproduction purposes is performed at low temperatures, which temperaturesmay be lowered during log phase, during stationary phase, or both. Theterm “low temperature” refers to temperatures of at least about 15° C.,more usually at least about 17° C., and may be about 20° C., and isusually not more than about 25° C., more usually not more than about 22°C. In another embodiment of the invention, the low temperature isusually not more than about 28° C. Growth temperature can impact theproduction of full-length secreted proteins in production cultures, anddecreasing the culture growth temperature can strongly enhance theintact product yield. The decreased temperature appears to assistintracellular trafficking through the folding and post-translationalprocessing pathways used by the host to generate the target product,along with reduction of cellular protease degradation.

The methods of the invention provide for expression of secreted, activeprotein, preferably a mammalian protein. In one embodiment, secreted,“active antibodies”, as used herein, refers to a correctly foldedmultimer of at least two properly paired chains, which accurately bindsto its cognate antigen. Expression levels of active protein are usuallyat least about 10-50 mg/liter culture, more usually at least about 100mg/liter, preferably at least about 500 mg/liter, and may be 1000mg/liter or more.

The methods of the invention can provide for increased stability of thehost and heterologous coding sequences during production. The stabilityis evidenced, for example, by maintenance of high levels of expressionof time, where the starting level of expression is decreased by not morethan about 20%, usually not more than 10%, and may be decreased by notmore than about 5% over about 20 doublings, 50 doublings, 100 doublings,or more.

The strain stability also provides for maintenance of heterologous genesequence integrity over time, where the sequence of the active codingsequence and requisite transcriptional regulatory elements aremaintained in at least about 99% of the diploid cells, usually in atleast about 99.9% of the diploid cells, and preferably in at least about99.99% of the diploid cells over about 20 doublings, 50 doublings, 100doublings, or more. Preferably, substantially all of the diploid cellsmaintain the sequence of the active coding sequence and requisitetranscriptional regulatory elements.

Other methods of producing antibodies are well known to those ofordinary skill in the art. For example, methods of producing chimericantibodies are now well known in the art. See, e.g., U.S. Pat. No.4,816,567; Morrison, et al. (1984) PNAS USA 81: 8651-55; Neuberger, etal. (1985) Nature 314: 268-270; Boulianne, et al. (1984) Nature 312:643-46.

Likewise, other methods of producing humanized antibodies are now wellknown in the art. See, e.g., U.S. Pat. Nos. 5,225,539; 5,530,101;5,585,089; 5,693,762; 6,054,297; 6,180,370; 6,407,213; 6,548,640;6,632,927; and 6,639,055; Jones, et al. (1986) Nature 321: 522-525;Reichmann, et al. (1988) Nature 332: 323-327; Verhoeyen, et al. (1988)Science 239: 1534-36.

Antibody polypeptides of the invention having IL-6 binding specificitymay also be produced by constructing, using conventional techniques wellknown to those of ordinary skill in the art, an expression vectorcontaining an operon and a DNA sequence encoding an antibody heavy chainin which the DNA sequence encoding the CDRs required for antibodyspecificity is derived from a non-human cell source, preferably a rabbitB-cell source, while the DNA sequence encoding the remaining parts ofthe antibody chain is derived from a human cell source.

A second expression vector is produced using the same conventional meanswell known to those of ordinary skill in the art, said expression vectorcontaining an operon and a DNA sequence encoding an antibody light chainin which the DNA sequence encoding the CDRs required for antibodyspecificity is derived from a non-human cell source, preferably a rabbitB-cell source, while the DNA sequence encoding the remaining parts ofthe antibody chain is derived from a human cell source.

The expression vectors are transfected into a host cell by conventiontechniques well known to those of ordinary skill in the art to produce atransfected host cell, said transfected host cell cultured byconventional techniques well known to those of ordinary skill in the artto produce said antibody polypeptides.

The host cell may be co-transfected with the two expression vectorsdescribed above, the first expression vector containing DNA encoding anoperon and a light chain-derived polypeptide and the second vectorcontaining DNA encoding an operon and a heavy chain-derived polypeptide.The two vectors contain different selectable markers, but preferablyachieve substantially equal expression of the heavy and light chainpolypeptides. Alternatively, a single vector may be used, the vectorincluding DNA encoding both the heavy and light chain polypeptides. Thecoding sequences for the heavy and light chains may comprise cDNA.

The host cells used to express the antibody polypeptides may be either abacterial cell such as E. coli, or a eukaryotic cell. In a particularlypreferred embodiment of the invention, a mammalian cell of awell-defined type for this purpose, such as a myeloma cell or a Chinesehamster ovary (CHO) cell line may be used.

The general methods by which the vectors may be constructed,transfection methods required to produce the host cell and culturingmethods required to produce the antibody polypeptides from said hostcells all include conventional techniques. Although preferably the cellline used to produce the antibody is a mammalian cell line, any othersuitable cell line, such as a bacterial cell line such as an E.coli-derived bacterial strain, or a yeast cell line, may alternativelybe used.

Similarly, once produced the antibody polypeptides may be purifiedaccording to standard procedures in the art, such as for examplecross-flow filtration, ammonium sulphate precipitation, affinity columnchromatography and the like.

The antibody polypeptides described herein may also be used for thedesign and synthesis of either peptide or non-peptide mimetics thatwould be useful for the same therapeutic applications as the antibodypolypeptides of the invention. See, e.g., Saragobi et al. (1991) Science253: 792-795.

B-Cell Screening and Isolation

The present invention provides methods of isolating a clonal populationof antigen-specific B cells that may be used for isolating at least oneantigen-specific cell. As described and exemplified infra, these methodscontain a series of culture and selection steps that can be usedseparately, in combination, sequentially, repetitively, or periodically.Preferably, these methods are used for isolating at least oneantigen-specific cell, which can be used to produce a monoclonalantibody, which is specific to a desired antigen, or a nucleic acidsequence corresponding to such an antibody.

The present invention provides a method comprising the steps of:

-   (a) preparing a cell population comprising at least one    antigen-specific B cell;-   (b) enriching the cell population, e.g., by chromatography, to form    an enriched cell population comprising at least one antigen-specific    B cell;-   (c) isolating a single B cell from the enriched B cell population;    and-   (d) determining whether the single B cell produces an antibody    specific to the antigen.

The present invention provides an improvement to a method of isolating asingle, antibody-producing B cell, the improvement comprising enrichinga B cell population obtained from a host that has been immunized ornaturally exposed to an antigen, wherein the enriching step precedes anyselection steps, comprises at least one culturing step, and results in aclonal population of B cells that produces a single monoclonal antibodyspecific to said antigen.

Throughout this application, a “clonal population of B cells” refers toa population of B cells that only secrete a single antibody specific toa desired antigen. That is to say that these cells produce only one typeof monoclonal antibody specific to the desired antigen.

In the present application, “enriching” a cell population cells meansincreasing the frequency of desired cells, typically antigen-specificcells, contained in a mixed cell population, e.g., a B cell-containingisolate derived from a host that is immunized against a desired antigen.Thus, an enriched cell population encompasses a cell population having ahigher frequency of antigen-specific cells as a result of an enrichmentstep, but this population of cells may contain and produce differentantibodies.

The general term “cell population” encompasses pre- and apost-enrichment cell populations, keeping in mind that when multipleenrichment steps are performed, a cell population can be both pre- andpost-enrichment. For example, in one embodiment, the present inventionprovides a method:

-   (a) harvesting a cell population from an immunized host to obtain a    harvested cell population;-   (b) creating at least one single cell suspension from the harvested    cell population;-   (c) enriching at least one single cell suspension to form a first    enriched cell population;-   (d) enriching the first enriched cell population to form a second    enriched cell population;-   (e) enriching the second enriched cell population to form a third    enriched cell population; and-   (f) selecting an antibody produced by an antigen-specific cell of    the third enriched cell population.

Each cell population may be used directly in the next step, or it can bepartially or wholly frozen for long- or short-term storage or for latersteps. Also, cells from a cell population can be individually suspendedto yield single cell suspensions. The single cell suspension can beenriched, such that a single cell suspension serves as thepre-enrichment cell population. Then, at least one antigen-specificsingle cell suspensions together form the enriched cell population; theantigen-specific single cell suspensions can be grouped together, e.g.,re-plated for further analysis and/or antibody production.

In one embodiment, the present invention provides a method of enrichinga cell population to yield an enriched cell population having anantigen-specific cell frequency that is about 50% to about 100%, orincrements therein. Preferably, the enriched cell population has anantigen-specific cell frequency at least about 50%, 60%, 70%, 75%, 80%,90%, 95%, 99%, or 100%.

In another embodiment, the present invention provides a method ofenriching a cell population whereby the frequency of antigen-specificcells is increased by at least about 2-fold, 5-fold, 10-fold, 20-fold,50-fold, 100-fold, or increments therein.

Throughout this application, the term “increment” is used to define anumerical value in varying degrees of precision, e.g., to the nearest10, 1, 0.1, 0.01. The increment can be rounded to any measurable degreeof precision, and the increment need not be rounded to the same degreeof precision on both sides of a range. For example, the range 1 to 100or increments therein includes ranges such as 20 to 80, 5 to 50, and 0.4to 98. When a range is open-ended, e.g., a range of less than 100,increments therein means increments between 100 and the measurablelimit. For example, less than 100 or increments therein means 0 to 100or increments therein unless the feature, e.g., temperature, is notlimited by 0.

Antigen-specificity can be measured with respect to any antigen. Theantigen can be any substance to which an antibody can bind including,but not limited to, peptides, proteins or fragments thereof;carbohydrates; organic and inorganic molecules; receptors produced byanimal cells, bacterial cells, and viruses; enzymes; agonists andantagonists of biological pathways; hormones; and cytokines. Exemplaryantigens include, but are not limited to, IL-2, IL-4, IL-6, IL-10,IL-12, IL-13, IL-18, IFN-α, IFN-γ, BAFF, CXCL13, IP-10, VEGF, EPO, EGF,HRG, Hepatocyte Growth Factor (HGF) and Hepcidin. Preferred antigensinclude IL-6, IL-13, TNF-α, VEGF-α, Hepatocyte Growth Factor (HGF) andHepcidin. In a method utilizing more than one enrichment step, theantigen used in each enrichment step can be the same as or differentfrom one another. Multiple enrichment steps with the same antigen mayyield a large and/or diverse population of antigen-specific cells;multiple enrichment steps with different antigens may yield an enrichedcell population with cross-specificity to the different antigens.

Enriching a cell population can be performed by any cell-selection meansknown in the art for isolating antigen-specific cells. For example, acell population can be enriched by chromatographic techniques, e.g.,Miltenyi bead or magnetic bead technology. The beads can be directly orindirectly attached to the antigen of interest. In a preferredembodiment, the method of enriching a cell population includes at leastone chromatographic enrichment step.

A cell population can also be enriched by performed by anyantigen-specificity assay technique known in the art, e.g., an ELISAassay or a halo assay. ELISA assays include, but are not limited to,selective antigen immobilization (e.g., biotinylated antigen capture bystreptavidin, avidin, or neutravidin coated plate), non-specific antigenplate coating, and through an antigen build-up strategy (e.g., selectiveantigen capture followed by binding partner addition to generate aheteromeric protein-antigen complex). The antigen can be directly orindirectly attached to a solid matrix or support, e.g., a column. A haloassay comprises contacting the cells with antigen-loaded beads andlabeled anti-host antibody specific to the host used to harvest the Bcells. The label can be, e.g., a fluorophore. In one embodiment, atleast one assay enrichment step is performed on at least one single cellsuspension. In another embodiment, the method of enriching a cellpopulation includes at least one chromatographic enrichment step and atleast one assay enrichment step.

Methods of “enriching” a cell population by size or density are known inthe art. See, e.g., U.S. Pat. No. 5,627,052. These steps can be used inthe present method in addition to enriching the cell population byantigen-specificity.

The cell populations of the present invention contain at least one cellcapable of recognizing an antigen. Antigen-recognizing cells include,but are not limited to, B cells, plasma cells, and progeny thereof. Inone embodiment, the present invention provides a clonal cell populationcontaining a single type of antigen-specific B-cell, i.e., the cellpopulation produces a single monoclonal antibody specific to a desiredantigen.

In such embodiment, it is believed that the clonal antigen-specificpopulation of B cells consists predominantly of antigen-specific,antibody-secreting cells, which are obtained by the novel culture andselection protocol provided herein. Accordingly, the present inventionalso provides methods for obtaining an enriched cell populationcontaining at least one antigen-specific, antibody-secreting cell. Inone embodiment, the present invention provides an enriched cellpopulation containing about 50% to about 100%, or increments therein, atleast about 60%, 70%, 80%, 90%, or 100% of antigen-specific,antibody-secreting cells.

In one embodiment, the present invention provides a method of isolatinga single B cell by enriching a cell population obtained from a hostbefore any selection steps, e.g., selecting a particular B cell from acell population and/or selecting an antibody produced by a particularcell. The enrichment step can be performed as one, two, three, or moresteps. In one embodiment, a single B cell is isolated from an enrichedcell population before confirming whether the single B cell secretes anantibody with antigen-specificity and/or a desired property.

In one embodiment, a method of enriching a cell population is used in amethod for antibody production and/or selection. Thus, the presentinvention provides a method comprising enriching a cell populationbefore selecting an antibody. The method can include the steps of:preparing a cell population comprising at least one antigen-specificcell, enriching the cell population by isolating at least oneantigen-specific cell to form an enriched cell population, and inducingantibody production from at least one antigen-specific cell. In apreferred embodiment, the enriched cell population contains more thanone antigen-specific cell. In one embodiment, each antigen-specific cellof the enriched population is cultured under conditions that yield aclonal antigen-specific B cell population before isolating an antibodyproducing cell therefrom and/or producing an antibody using said B cell,or a nucleic acid sequence corresponding to such an antibody. Incontrast to prior techniques where antibodies are produced from a cellpopulation with a low frequency of antigen-specific cells, the presentinvention allows antibody selection from among a high frequency ofantigen-specific cells. Because an enrichment step is used prior toantibody selection, the majority of the cells, preferably virtually allof the cells, used for antibody production are antigen-specific. Byproducing antibodies from a population of cells with an increasedfrequency of antigen specificity, the quantity and variety of antibodiesare increased.

In the antibody selection methods of the present invention, an antibodyis preferably selected after an enrichment step and a culture step thatresults in a clonal population of antigen-specific B cells. The methodscan further comprise a step of sequencing a selected antibody orportions thereof from at least one isolated, antigen-specific cells. Anymethod known in the art for sequencing can be employed and can includesequencing the heavy chain, light chain, variable region(s), and/orcomplementarity determining region(s) (CDR).

In addition to the enrichment step, the method for antibody selectioncan also include at least one steps of screening a cell population forantigen recognition and/or antibody functionality. For example, thedesired antibodies may have specific structural features, such asbinding to a particular epitope or mimicry of a particular structure;antagonist or agonist activity; or neutralizing activity, e.g.,inhibiting binding between the antigen and a ligand. In one embodiment,the antibody functionality screen is ligand-dependent. Screening forantibody functionality includes, but is not limited to, an in vitroprotein-protein interaction assay that recreates the natural interactionof the antigen ligand with recombinant receptor protein; and acell-based response that is ligand dependent and easily monitored (e.g.,proliferation response).

In one embodiment, the method for antibody selection includes a step ofscreening the cell population for antibody functionality by measuringthe inhibitory concentration (IC50). In one embodiment, at least one ofthe isolated, antigen-specific cells produces an antibody having an IC50of less than about 100, 50, 30, 25, 10 μg/mL, or increments therein.

In addition to the enrichment step, the method for antibody selectioncan also include at least one steps of screening a cell population forantibody binding strength. Antibody binding strength can be measured byany method known in the art (e.g., Biacore®). In one embodiment, atleast one of the isolated, antigen-specific cells produces an antibodyhaving a high antigen affinity, e.g., a dissociation constant (Kd) ofless than about 5×10¹⁰ M-1, preferably about 1×10⁻¹³ to 5×10⁻²⁰, 1×10⁻¹²to 1×10⁻¹¹, 1×10⁻¹² to 7.5×10⁻ ¹¹, 1×10⁻¹¹ to 2×10⁻¹¹, about 1.5×10⁻¹¹or less, or increments therein. In this embodiment, the antibodies aresaid to be affinity mature. In a preferred embodiment, the affinity ofthe antibodies is comparable to or higher than the affinity of any oneof Panorex® (edrecolomab), Rituxan® (rituximab), Herceptin®(traztuzumab), Mylotarg® (gentuzumab), Campath® (alemtuzumab), Zevalin®(ibritumomab), Erbitux® (cetuximab), Avastin® (bevicizumab), Raptiva®(efalizumab), Remicade® (infliximab), Humira® (adalimumab), or Xolair®(omalizumab). Preferably, the affinity of the antibodies is comparableto or higher than the affinity of Humira®. The affinity of an antibodycan also be increased by known affinity maturation techniques. In oneembodiment, at least one cell population is screened for at least oneof, preferably both, antibody functionality and antibody bindingstrength.

In addition to the enrichment step, the method for antibody selectioncan also include at least one steps of screening a cell population forantibody sequence homology, especially human homology. In oneembodiment, at least one of the isolated, antigen-specific cellsproduces an antibody that has a homology to a human antibody of at leastabout 50% to about 100%, or increments therein, or at least about 60%,70%, 80%, 85%, 90%, or 95% homologous. The antibodies can be humanizedto increase the homology to a human sequence by techniques known in theart such as CDR grafting or selectivity determining residue grafting(SDR).

In another embodiment, the present invention also provides theantibodies themselves according to any of the embodiments describedabove in terms of IC50, Kd, and/or homology.

Methods of Humanizing Antibodies

The invention also provides a method for humanizing antibody heavy andlight chains. In this embodiment, the following method may be followedfor the humanization of the heavy and light chains:

Light Chain

1. Identify the amino acid that is the first one following the signalpeptide sequence. This is the start of Framework 1. The signal peptidestarts at the first initiation methionine and is typically, but notnecessarily 22 amino acids in length for rabbit light chain proteinsequences. The start of the mature polypeptide can also be determinedexperimentally by N-terminal protein sequencing, or can be predictedusing a prediction algorithm. This is also the start of Framework 1 asclassically defined by those in the field.

Example RbtVL Amino Acid Residue 1 in FIG. 1, Starting ‘AYDM . . . ’(SEQ ID NO: 733)

2. Identify the end of Framework

3. This is typically 86-90 amino acids following the start of Framework1 and is typically a cysteine residue preceded by two tyrosine residues.This is the end of the Framework 3 as classically defined by those inthe field.

Example RbtVL Amino Acid Residue 88 in FIG. 1, Ending as ‘TYYC’ (SEQ IDNO: 733)

3. Use the rabbit light chain sequence of the polypeptide starting fromthe beginning of Framework 1 to the end of Framework 3 as defined aboveand perform a sequence homology search for the most similar humanantibody protein sequences. This will typically be a search againsthuman germline sequences prior to antibody maturation in order to reducethe possibility of immunogenicity, however any human sequences can beused. Typically a program like BLAST can be used to search a database ofsequences for the most homologous. Databases of human antibody sequencescan be found from various sources such as NCBI (National Center forBiotechnology Information).

Example

RbtVL amino acid sequence from residues numbered 1 through 88 in FIG. 1is BLASTed against a human antibody germline database. The top threeunique returned sequences are shown in FIG. 1 as L12A (SEQ ID NO: 734),V1 (SEQ ID NO: 735), and Vx02 (SEQ ID NO: 736).

4. Generally the most homologous human germline variable light chainsequence is then used as the basis for humanization. However thoseskilled in the art may decide to use another sequence that wasn't thehighest homology as determined by the homology algorithm, based on otherfactors including sequence gaps and framework similarities.

Example

In FIG. 1, L12A (SEQ ID NO: 734) was the most homologous human germlinevariable light chain sequence and is used as the basis for thehumanization of RbtVL.

5. Determine the framework and CDR arrangement (FR1, FR2, FR3, CDR1 &CDR2) for the human homolog being used for the light chain humanization.This is using the traditional layout as described in the field. Alignthe rabbit variable light chain sequence with the human homolog, whilemaintaining the layout of the framework and CDR regions.

Example

In FIG. 1, the RbtVL sequence is aligned with the human homologoussequence L12A, and the framework and CDR domains are indicated.

6. Replace the human homologous light chain sequence CDR1 and CDR2regions with the CDR1 and CDR2 sequences from the rabbit sequence. Ifthere are differences in length between the rabbit and human CDRsequences then use the entire rabbit CDR sequences and their lengths. Itis possible that the specificity, affinity and/or immunogenicity of theresulting humanized antibody may be unaltered if smaller or largersequence exchanges are performed, or if specific residue(s) are altered,however the exchanges as described have been used successfully, but donot exclude the possibility that other changes may be permitted.

Example

In FIG. 1, the CDR1 and CDR2 amino acid residues of the human homologousvariable light chain L12A are replaced with the CDR1 and CDR2 amino acidsequences from the RbtVL rabbit antibody light chain sequence. The humanL12A frameworks 1, 2 and 3 are unaltered. The resulting humanizedsequence is shown below as VLh from residues numbered 1 through 88. Notethat the only residues that are different from the L12A human sequenceare underlined, and are thus rabbit-derived amino acid residues. In thisexample only 8 of the 88 residues are different than the human sequence.

7. After framework 3 of the new hybrid sequence created in Step 6,attach the entire CDR3 of the rabbit light chain antibody sequence. TheCDR3 sequence can be of various lengths, but is typically 9 to 15 aminoacid residues in length. The CDR3 region and the beginning of thefollowing framework 4 region are defined classically and identifiable bythose skilled in the art. Typically the beginning of Framework 4, andthus after the end of CDR3 consists of the sequence ‘FGGG . . . ’ (SEQID NO: 743), however some variation may exist in these residues.

Example

In FIG. 1, the CDR3 of RbtVL (amino acid residues numbered 89-100) isadded after the end of framework 3 in the humanized sequence indicatedas VLh.

8. The rabbit light chain framework 4, which is typically the final 11amino acid residues of the variable light chain and begins as indicatedin Step 7 above and typically ends with the amino acid sequence ‘ . . .VVKR’ (SEQ ID NO: 744) is replaced with the nearest human light chainframework 4 homolog, usually from germline sequence. Frequently thishuman light chain framework 4 is of the sequence ‘FGGGTKVEIKR’ (SEQ IDNO: 745). It is possible that other human light chain framework 4sequences that are not the most homologous or otherwise different may beused without affecting the specificity, affinity and/or immunogenicityof the resulting humanized antibody. This human light chain framework 4sequence is added to the end of the variable light chain humanizedsequence immediately following the CDR3 sequence from Step 7 above. Thisis now the end of the variable light chain humanized amino acidsequence.

Example

In FIG. 1, Framework 4 (FR4) of the RbtVL rabbit light chain sequence isshown above a homologous human FR4 sequence. The human FR4 sequence isadded to the humanized variable light chain sequence (VLh) right afterthe end of the CD3 region added in Step 7 above.

In addition, FIGS. 4 and 5 depict preferred humanized anti-IL-6 variableheavy and variable light chain sequences humanized from the variableheavy and light regions in Ab1 according to the invention. Thesehumanized light and heavy chain regions are respectively contained inthe polypeptides set forth in SEQ ID NO: 647, or 651 and in SEQ ID NO:652, 656, 657 or 658. The CDR2 of the humanized variable heavy region inSEQ ID NO: 657 (containing a serine substitution in CDR2) is set forthin SEQ ID NO: 658. Alignments illustrating variants of the light andheavy chains are shown in FIGS. 2 and 3, respectively, with sequencedifferences within the CDR regions highlighted. Sequence identifiers ofCDR sequences and of exemplary coding sequences are summarized in Table4, above.

Heavy Chain

1. Identify the amino acid that is the first one following the signalpeptide sequence. This is the start of Framework 1. The signal peptidestarts at the first initiation methionine and is typically 19 aminoacids in length for rabbit heavy chain protein sequences. Typically, butnot necessarily always, the final 3 amino acid residues of a rabbitheavy chain signal peptide are ‘ . . . VQC’, followed by the start ofFramework 1. The start of the mature polypeptide can also be determinedexperimentally by N-terminal protein sequencing, or can be predictedusing a prediction algorithm. This is also the start of Framework 1 asclassically defined by those in the field.

Example RbtVH Amino Acid Residue 1 in FIG. 1, Starting ‘QEQL . . . ’(SEQ ID NO: 738)

2. Identify the end of Framework 3. This is typically 95-100 amino acidsfollowing the start of Framework 1 and typically has the final sequenceof ‘ . . . CAR’ (although the alanine can also be a valine). This is theend of the Framework 3 as classically defined by those in the field.

Example RbtVH Amino Acid Residue 98 in FIG. 1, Ending as ‘ . . . FCVR’(SEQ ID NO: 738)

3. Use the rabbit heavy chain sequence of the polypeptide starting fromthe beginning of Framework 1 to the end of Framework 3 as defined aboveand perform a sequence homology search for the most similar humanantibody protein sequences. This will typically be against a database ofhuman germline sequences prior to antibody maturation in order to reducethe possibility of immunogenicity, however any human sequences can beused. Typically a program like BLAST can be used to search a database ofsequences for the most homologous. Databases of human antibody sequencescan be found from various sources such as NCBI (National Center forBiotechnology Information).

Example

RbtVH amino acid sequence from residues numbered 1 through 98 in FIG. 1is BLASTed against a human antibody germline database. The top threeunique returned sequences are shown in FIG. 1 as 3-64-04 (SEQ ID NO:739), 3-66-04 (SEQ ID NO: 740), and 3-53-02 (SEQ ID NO: 741).

4. Generally the most homologous human germline variable heavy chainsequence is then used as the basis for humanization. However thoseskilled in the art may decide to use another sequence that wasn't themost homologous as determined by the homology algorithm, based on otherfactors including sequence gaps and framework similarities.

Example

3-64-04 in FIG. 1 was the most homologous human germline variable heavychain sequence and is used as the basis for the humanization of RbtVH.

5. Determine the framework and CDR arrangement (FR1, FR2, FR3, CDR1 &CDR2) for the human homolog being used for the heavy chain humanization.This is using the traditional layout as described in the field. Alignthe rabbit variable heavy chain sequence with the human homolog, whilemaintaining the layout of the framework and CDR regions.

Example

In FIG. 1, the RbtVH sequence is aligned with the human homologoussequence 3-64-04, and the framework and CDR domains are indicated.

6. Replace the human homologous heavy chain sequence CDR1 and CDR2regions with the CDR1 and CDR2 sequences from the rabbit sequence. Ifthere are differences in length between the rabbit and human CDRsequences then use the entire rabbit CDR sequences and their lengths. Inaddition, it may be necessary to replace the final three amino acids ofthe human heavy chain Framework 1 region with the final three aminoacids of the rabbit heavy chain Framework 1. Typically but not always,in rabbit heavy chain Framework 1 these three residues follow a Glycineresidue preceded by a Serine residue. In addition, it may be necessaryreplace the final amino acid of the human heavy chain Framework 2 regionwith the final amino acid of the rabbit heavy chain Framework 2.Typically, but not necessarily always, this is a Glycine residuepreceded by an Isoleucine residue in the rabbit heavy chain Framework 2.It is possible that the specificity, affinity and/or immunogenicity ofthe resulting humanized antibody may be unaltered if smaller or largersequence exchanges are performed, or if specific residue(s) are altered,however the exchanges as described have been used successfully, but donot exclude the possibility that other changes may be permitted. Forexample, a tryptophan amino acid residue typically occurs four residuesprior to the end of the rabbit heavy chain CDR2 region, whereas in humanheavy chain CDR2 this residue is typically a Serine residue. Changingthis rabbit tryptophan residue to a the human Serine residue at thisposition has been demonstrated to have minimal to no effect on thehumanized antibody's specificity or affinity, and thus further minimizesthe content of rabbit sequence-derived amino acid residues in thehumanized sequence.

Example

In FIG. 1, The CDR1 and CDR2 amino acid residues of the human homologousvariable heavy chain are replaced with the CDR1 and CDR2 amino acidsequences from the RbtVH rabbit antibody light chain sequence, exceptfor the boxed residue, which is tryptophan in the rabbit sequence(position number 63) and Serine at the same position in the humansequence, and is kept as the human Serine residue. In addition to theCDR1 and CDR2 changes, the final three amino acids of Framework 1(positions 28-30) as well as the final residue of Framework 2 (position49) are retained as rabbit amino acid residues instead of human. Theresulting humanized sequence is shown below as VHh from residuesnumbered 1 through 98. Note that the only residues that are differentfrom the 3-64-04 human sequence are underlined, and are thusrabbit-derived amino acid residues. In this example only 15 of the 98residues are different than the human sequence.

7. After framework 3 of the new hybrid sequence created in Step 6,attach the entire CDR3 of the rabbit heavy chain antibody sequence. TheCDR3 sequence can be of various lengths, but is typically 5 to 19 aminoacid residues in length. The CDR3 region and the beginning of thefollowing framework 4 region are defined classically and areidentifiable by those skilled in the art. Typically the beginning offramework 4, and thus after the end of CDR3 consists of the sequenceWGXG . . . (where X is usually Q or P) (SEQ ID NO: 746), however somevariation may exist in these residues.

Example

The CDR3 of RbtVH (amino acid residues numbered 99-110) is added afterthe end of framework 3 in the humanized sequence indicated as VHh.

8. The rabbit heavy chain framework 4, which is typically the final 11amino acid residues of the variable heavy chain and begins as indicatedin Step 7 above and typically ends with the amino acid sequence ‘ . . .TVSS’ (SEQ ID NO: 747) is replaced with the nearest human heavy chainframework 4 homolog, usually from germline sequence. Frequently thishuman heavy chain framework 4 is of the sequence ‘WGQGTLVTVSS’ (SEQ IDNO: 748). It is possible that other human heavy chain framework 4sequences that are not the most homologous or otherwise different may beused without affecting the specificity, affinity and/or immunogenicityof the resulting humanized antibody. This human heavy chain framework 4sequence is added to the end of the variable heavy chain humanizedsequence immediately following the CDR3 sequence from Step 7 above. Thisis now the end of the variable heavy chain humanized amino acidsequence.

Example

In FIG. 1, framework 4 (FR4) of the RbtVH rabbit heavy chain sequence isshown above a homologous human heavy FR4 sequence. The human FR4sequence is added to the humanized variable heavy chain sequence (VHh)right after the end of the CD3 region added in Step 7 above.

Additional Exemplary Embodiments of the Invention

In another embodiment, the invention contemplates at least one anti-IL-6antibodies or antibody fragments or variants thereof which mayspecifically bind to the same linear or conformational epitope(s) and/orcompete for binding to the same linear or conformational epitope(s) onan intact human IL-6 polypeptide or fragment thereof as an anti-IL-6antibody comprising Ab1 and chimeric, humanized, single chain antibodiesand fragments thereof (containing at least one CDRs of theafore-identified antibodies) that specifically bind IL-6, whichpreferably are aglycosylated. In a preferred embodiment, the anti-IL-6antibody or fragment or variant thereof may specifically bind to thesame linear or conformational epitope(s) and/or compete for binding tothe same linear or conformational epitope(s) on an intact human IL-6polypeptide or a fragment thereof as Ab1 and chimeric, humanized, singlechain antibodies and fragments thereof (containing at least one CDRs ofthe afore-mentioned antibody) that specifically bind IL-6, whichpreferably are aglycosylated.

In another embodiment of the invention, the anti-IL-6 antibody which mayspecifically bind to the same linear or conformational epitopes on anintact IL-6 polypeptide or fragment thereof that is (are) specificallybound by Ab1 may bind to an IL-6 epitope(s) ascertained by epitopicmapping using overlapping linear peptide fragments which span the fulllength of the native human IL-6 polypeptide. In one embodiment of theinvention, the IL-6 epitope comprises, or alternatively consists of, atleast one residues comprised in IL-6 fragments selected from thoserespectively encompassing amino acid residues 37-51, amino acid residues70-84, amino acid residues 169-183, amino acid residues 31-45 and/oramino acid residues 58-72.

The invention is also directed to an anti-IL-6 antibody that binds withthe same IL-6 epitope and/or competes with an anti-IL-6 antibody forbinding to IL-6 as an antibody or antibody fragment disclosed herein,including but not limited to an anti-IL-6 antibody selected from Ab1 andchimeric, humanized, single chain antibodies and fragments thereof(containing at least one CDRs of the afore-mentioned antibody) thatspecifically bind IL-6, which preferably are aglycosylated.

In another embodiment, the invention is also directed to an isolatedanti-IL-6 antibody or antibody fragment or variant thereof comprising atleast one of the CDRs contained in the V_(H) polypeptide sequencescomprising: SEQ ID NO: 3, 18, 19, 22, 38, 54, 70, 86, 102, 117, 118,123, 139, 155, 171, 187, 203, 219, 235, 251, 267, 283, 299, 315, 331,347, 363, 379, 395, 411, 427, 443, 459, 475, 491, 507, 523, 539, 555,571, 652, 656, 657, 658, 661, 664, 665, 668, 672, 676, 680, 684, 688,691, 692, 704, or 708 and/or at least one of the CDRs contained in theV_(I), polypeptide sequence consisting of: 2, 20, 21, 37, 53, 69, 85,101, 119, 122, 138, 154, 170, 186, 202, 218, 234, 250, 266, 282, 298,314, 330, 346, 362, 378, 394, 410, 426, 442, 458, 474, 490, 506, 522,538, 554, 570, 647, 651, 660, 666, 667, 671, 675, 679, 683, 687, 693,699, 702, 706, or 709 and the VH and VL sequences depicted in theantibody alignments comprised in FIGS. 1-5 of this application.

In one embodiment of the invention, the anti-IL-6 antibody describedherein may comprise at least 2 complementarity determining regions(CDRs) in each the variable light and the variable heavy regions whichare identical to those contained in an anti-IL-6 antibody comprising Ab1and chimeric, humanized, single chain antibodies and fragments thereof(containing at least one CDRs of the afore-mentioned antibody) thatspecifically bind IL-6, which preferably are aglycosylated.

In a preferred embodiment, the anti-IL-6 antibody described herein maycomprise at least 2 complementarity determining regions (CDRs) in eachthe variable light and the variable heavy regions which are identical tothose contained in Ab1. In another embodiment, all of the CDRs of theanti-IL-6 antibody discussed above are identical to the CDRs containedin an anti-IL-6 antibody comprising Ab1 and chimeric, humanized, singlechain antibodies and fragments thereof (containing at least one CDRs ofthe afore-mentioned antibody) that specifically bind IL-6, whichpreferably are aglycosylated. In a preferred embodiment of theinvention, all of the CDRs of the anti-IL-6 antibody discussed above areidentical to the CDRs contained in Ab1, e.g., an antibody comprised ofthe VH and VL sequences comprised in SEQ ID NO: 657 and SEQ ID NO: 709respectively.

The invention further contemplates that the one or more anti-IL-6antibodies discussed above are aglycosylated or substantiallynon-glycosylated (e.g., may contain one or more, e.g., 1-5 mannoseresidues); that contain an Fc region that has been modified to altereffector function, half-life, proteolysis, and/or glycosylation; arehuman, humanized, single chain or chimeric; and are a humanized antibodyderived from a rabbit (parent) anti-IL-6 antibody. Exemplary constantregions that provide for the production of aglycosylated antibodies inPichia are comprised in SEQ ID NO: 588 and SEQ ID NO: 586 whichrespectively are encoded by the nucleic acid sequences in SEQ ID NO: 589and SEQ ID NO: 587.

The invention further contemplates at least one anti-IL-6 antibodieswherein the framework regions (FRs) in the variable light region and thevariable heavy regions of said antibody respectively are human FRs whichare unmodified or which have been modified by the substitution of atmost 2 or 3 human FR residues in the variable light or heavy chainregion with the corresponding FR residues of the parent rabbit antibody,and wherein said human FRs have been derived from human variable heavyand light chain antibody sequences which have been selected from alibrary of human germline antibody sequences based on their high levelof homology to the corresponding rabbit variable heavy or light chainregions relative to other human germline antibody sequences contained inthe library.

In one embodiment of the invention, the anti-IL-6 antibody or fragmentor variant thereof may specifically bind to IL-6 expressing human cellsand/or to circulating soluble IL-6 molecules in vivo, including IL-6expressed on or by human cells in a patient with a disease associatedwith cells that express IL-6.

The invention further contemplates anti-IL-6 antibodies or fragments orvariants thereof directly or indirectly attached to a detectable labelor therapeutic agent.

The invention also contemplates at least one nucleic acid sequenceswhich result in the expression of an anti-IL-6 antibody or antibodyfragment or variant thereof as set forth above, including thosecomprising, or alternatively consisting of, yeast or human preferredcodons. The invention also contemplates vectors (including plasmids orrecombinant viral vectors) comprising said nucleic acid sequence(s). Theinvention also contemplates host cells or recombinant host cellsexpressing at least one of the antibodies set forth above, including amammalian, yeast, bacterial, and insect cells. In a preferredembodiment, the host cell is a yeast cell. In a further preferredembodiment, the yeast cell is a diploidal yeast cell. In a morepreferred embodiment, the yeast cell is a Pichia yeast.

The invention also contemplates a method of treatment comprisingadministering to a patient with a disease or condition associated withmucositis a therapeutically effective amount of at least one anti-IL-6antibody or antibody fragment or variant thereof. The diseases that maybe treated are presented in the non-limiting list set forth above. Inanother embodiment the treatment further includes the administration ofanother therapeutic agent or regimen selected from chemotherapy,radiotherapy, cytokine administration or gene therapy agent. Forexample, TNF-α inhibitors including but not limited to glyococordicoids,triamcinolone, dexamethasone, prednisone, may also be administeredsequentially or subsequently with at least one anti-IL-6 antibody orantibody fragment or variant thereof described herein. Further examplesof drugs that may be included with the IL-6 antagonists include but arenot limited to ARISTOCORT® (triamcinolone), BAYCADROM® (dexamethasone),DECADRON® (dexamethasone), DELTASONE® (prednisone), DEXAMETHASONEINTENSOL® (dexamethasone), ENBREL® (etancercept), HUMIRA® (adalimumab),REMICADE® (infliximab), RIDUARA® (aruaofin), and SIMPONI® (golimumab).

Exemplary Embodiments of Heavy and Light Chain Polypeptides andPolynucleotides

This section recites exemplary embodiments of heavy and light chainpolypeptides, as well as exemplary polynucleotides encoding suchpolypeptides. These exemplary polynucleotides are suitable forexpression in the disclosed Pichia expression system.

In certain embodiments, the present invention encompassespolynucleotides having at least about 70%, 75%, 80%, 85%, 90%, 91%, 92%,93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity (sequencehomology) to the polynucleotides recited in this application or thatencode polypeptides recited in this application, or that hybridize tosaid polynucleotides under conditions of low-stringency,moderate-stringency, or high-stringency conditions, preferably thosethat encode polypeptides (e.g. an immunoglobulin heavy and light chain,a single-chain antibody, an antibody fragment) that have at least one ofthe biological activities set forth herein, including without limitationthereto specific binding to an IL-6 polypeptide. In another aspect, theinvention encompasses a composition comprising such a polynucleotideand/or a polypeptide encoded by such a polynucleotide. In yet anotheraspect, the invention encompasses a method of treatment of a disease orcondition associated with IL-6 or that may be prevented, treated, orameliorated with an IL-6 antagonist such as Ab1 (e.g. mucositis)comprising administration of a composition comprising such apolynucleotide and/or polypeptide.

In certain preferred embodiments, a heavy chain polypeptide willcomprise at least one of the CDR sequences of the heavy and/or lightchain polypeptides recited herein (including those contained in theheavy and light chain polypeptides recited herein) and at least one ofthe framework region polypeptides recited herein, including thosedepicted in FIGS. 1-5 or Table 4, and contained in the heavy and lightchain polypeptide sequences recited herein. In certain preferredembodiments, a heavy chain polypeptide will comprise at least oneFramework 4 region sequences as depicted in FIGS. 1-5 or Table 4, or ascontained in a heavy or light chain polypeptide recited herein.

In certain preferred embodiments, a light chain polypeptide willcomprise at least one of the CDR sequences of the heavy and/or lightchain polypeptides recited herein (including those contained in theheavy and light chain polypeptides recited herein) and at least one ofthe Framework region polypeptides recited herein, including thosedepicted in FIGS. 1-5 or Table 4, and contained in the heavy and lightchain polypeptide sequences recited herein. In certain preferredembodiments, a light chain polypeptide will comprise at least oneFramework 4 region sequences as depicted in FIGS. 1-5 or Table 4, or ascontained in a heavy or light chain polypeptide recited herein.

In any of the embodiments recited herein, certain of the sequencesrecited may be substituted for each other, unless the context indicatesotherwise. The recitation that particular sequences may be substitutedfor one another, where such recitations are made, are understood to beillustrative rather than limiting, and it is also understood that suchsubstitutions are encompassed even when no illustrative examples ofsubstitutions are recited, For example, wherever at least one of the Ab1light chain polypeptides is recited, e.g. any of SEQ ID NO: 2, 20, 647,651, 660, 666, 699, 702, 706, or 709, another Ab1 light chainpolypeptide may be substituted unless the context indicates otherwise.Similarly, wherever one of the Ab1 heavy chain polypeptides is recited,e.g. any of SEQ ID NO: 3, 18, 19, 652, 656, 657, 658, 661, 664, 665,704, or 708, another Ab1 heavy chain polypeptide may be substitutedunless the context indicates otherwise. Likewise, wherever one of theAb1 light chain polynucleotides is recited, e.g. any of SEQ ID NO: 10,662, 698, 701, or 705, another Ab1 light chain polynucleotide may besubstituted unless the context indicates otherwise. Similarly, whereverone of the Ab1 heavy chain polynucleotides is recited, e.g. any of SEQID NO: 11, 663, 700, 703, or 707, another Ab1 heavy chain polynucleotidemay be substituted unless the context indicates otherwise.

Additionally, recitation of any member of any of the following groups isunderstood to encompass substitution by any other member of the group,as follows: Ab2 Light chain polypeptides (SEQ ID NO: 21 and 667); Ab2Light chain polynucleotides (SEQ ID NO: 29 and 669); Ab2 Heavy chainpolypeptides (SEQ ID NO: 22 and 668); Ab2 Heavy chain polynucleotides(SEQ ID NO: 30 and 670); Ab3 Light chain polypeptides (SEQ ID NO: 37 and671); Ab3 Light chain polynucleotides (SEQ ID NO: 45 and 673); Ab3 Heavychain polypeptides (SEQ ID NO: 38 and 672); Ab3 Heavy chainpolynucleotides (SEQ ID NO: 46 and 674); Ab4 Light chain polypeptides(SEQ ID NO: 53 and 675); Ab4 Light chain polynucleotides (SEQ ID NO: 61and 677); Ab4 Heavy chain polypeptides (SEQ ID NO: 54 and 676); Ab4Heavy chain polynucleotides (SEQ ID NO: 62 and 678); Ab5 Light chainpolypeptides (SEQ ID NO: 69 and 679); Ab5 Light chain polynucleotides(SEQ ID NO: 77 and 681); Ab5 Heavy chain polypeptides (SEQ ID NO: 70 and680); Ab5 Heavy chain polynucleotides (SEQ ID NO: 78 and 682); Ab6 Lightchain polypeptides (SEQ ID NO: 85 and 683); Ab6 Light chainpolynucleotides (SEQ ID NO: 93 and 685); Ab6 Heavy chain polypeptides(SEQ ID NO: 86 and 684); Ab6 Heavy chain polynucleotides (SEQ ID NO: 94and 686); Ab7 Light chain polypeptides (SEQ ID NO: 101, 119, 687, 693);Ab7 Light chain polynucleotides (SEQ ID NO: 109 and 689); Ab7 Heavychain polypeptides (SEQ ID NO: 102, 117, 118, 688, 691, and 692); Ab7Heavy chain polynucleotides (SEQ ID NO: 110 and 690); Ab1 Light ChainCDR1 polynucleotides (SEQ ID NO: 12 and 694); Ab1 Light Chain CDR3polynucleotides (SEQ ID NO: 14 and 695); Ab1 Heavy Chain CDR2polynucleotides (SEQ ID NO: 16 and 696) and Ab1 Heavy Chain CDR3polynucleotides (SEQ ID NO: 17 and 697). Exemplary Ab1-encodingpolynucleotide sequences include but are not limited to SEQ ID NO: 662,663, 698, 700, 701, 703, 705, 707, 720, 721, 722, 723, 724, and 725.

Anti-IL-6 Activity

As stated previously, IL-6 is a member of a family of cytokines thatpromote cellular responses through a receptor complex consisting of atleast one subunit of the signal-transducing glycoprotein gp130 and theIL-6 receptor (IL-6R). The IL-6R may also be present in a soluble form(sIL-6R). IL-6 binds to IL-6R, which then dimerizes thesignal-transducing receptor gp130.

It is believed that the anti-IL-6 antibodies of the invention, or IL-6binding fragments or variants thereof, are useful by exhibitinganti-IL-6 activity. In one non-limiting embodiment of the invention, theanti-IL-6 antibodies of the invention, or IL-6 binding fragments orvariants thereof, exhibit anti-IL-6 activity by binding to IL-6 whichmay be soluble IL-6 or cell surface expressed IL-6 and/or may prevent orinhibit the binding of IL-6 to IL-6R and/or activation (dimerization) ofthe gp 130 signal-transducing glycoprotein and the formation ofIL-6/IL-6R/gp130 multimers and the biological effects of any of theforegoing. The subject anti-IL-6 antibodies may possess differentantagonistic activities based on where (i.e., epitope) the particularantibody binds IL-6 and/or how it affects the formation of the foregoingIL-6 complexes and/or multimers and the biological effects thereof.Consequently, different anti-IL-6 antibodies according to the inventione.g., may be better suited for preventing or treating conditionsinvolving the formation and accumulation of substantial soluble IL-6such as rheumatoid arthritis whereas other antibodies may be favored intreatments wherein the prevention of IL-6/IL-6R/gp130 orIL-6/IL-6R/gp130 multimers is a desired therapeutic outcome. This can bedetermined in binding and other assays.

The anti-IL-6 activity of the anti-IL-6 antibody of the presentinvention, and fragments and variants thereof having binding specificityto IL-6, may also be described by their strength of binding or theiraffinity for IL-6. This also may affect their therapeutic properties. Inone embodiment of the invention, the anti-IL-6 antibodies of the presentinvention, and fragments thereof having binding specificity to IL-6,bind to IL-6 with a dissociation constant (K_(D)) of less than or equalto 5×10⁻⁷, 10⁻⁷, 5×10⁻⁸, 10⁻⁸, 5×10⁻⁹, 10⁻⁹, 5×10⁻¹⁰, 10⁻¹⁰, 5×10⁻¹¹,10⁻¹¹, 5×10⁻¹², 10⁻¹², 5×10⁻¹³, 10⁻¹³, 5×10⁻¹⁴, 10⁻¹⁴, 5×10⁻¹⁵ or 10⁻¹⁵.Preferably, the anti-IL-6 antibodies and fragments and variants thereofbind IL-6 with a dissociation constant of less than or equal to 5×10⁻¹⁰.

In another embodiment of the invention, the anti-IL-6 activity of theanti-IL-6 antibodies of the present invention, and fragments andvariants thereof having binding specificity to IL-6, bind to IL-6 withan off-rate of less than or equal to 10⁻⁴ S⁻¹, 5×10⁻⁵ S⁻¹, 10⁻⁵ S⁻¹,5×10⁻⁶ S⁻¹, 10⁻⁶ S⁻¹, 5×10⁻⁷ S⁻¹, or 10⁻⁷ S⁻¹. In one embodiment of theinvention, the anti-IL-6 antibodies of the invention, and fragments andvariants thereof having binding specificity to IL-6, bind to a linear orconformational IL-6 epitope.

In a further embodiment of the invention, the anti-IL-6 activity of theanti-IL-6 antibodies of the present invention, and fragments andvariants thereof having binding specificity to IL-6, exhibit anti-IL-6activity by ameliorating or reducing the symptoms of, or alternativelytreating, or preventing, diseases and disorders associated with IL-6.Non-limiting examples of diseases and disorders associated with IL-6 areset forth infra. In another embodiment of the invention, the anti-IL-6antibodies described herein, or IL-6 binding fragments and variantsthereof, do not have binding specificity for IL-6R or the gp-130signal-transducing glycoprotein.

Screening Assays

The invention also includes screening assays designed to assist in theidentification of diseases and disorders associated with IL-6 inpatients exhibiting symptoms of an IL-6 associated disease or disorder,especially mucositis.

In one embodiment of the invention, the anti-IL-6 antibodies of theinvention, or IL-6 binding fragments or variants thereof, are used todetect the presence of IL-6 in a biological sample obtained from apatient exhibiting symptoms of a disease or disorder associated withIL-6. The presence of IL-6, or elevated levels thereof when compared topre-disease levels of IL-6 in a comparable biological sample, may bebeneficial in diagnosing a disease or disorder associated with IL-6.

Another embodiment of the invention provides a diagnostic or screeningassay to assist in diagnosis of diseases or disorders associated withIL-6 in patients exhibiting symptoms of an IL-6 associated disease ordisorder identified herein, comprising assaying the level of IL-6expression in a biological sample from said patient using apost-translationally modified anti-IL-6 antibody or binding fragment orvariant thereof. The anti-IL-6 antibody or binding fragment or variantthereof may be post-translationally modified to include a detectablemoiety such as set forth previously in the disclosure.

The IL-6 level in the biological sample is determined using a modifiedanti-IL-6 antibody or binding fragment or variant thereof as set forthherein, and comparing the level of IL-6 in the biological sample againsta standard level of IL-6 (e.g., the level in normal biological samples).The skilled clinician would understand that some variability may existbetween normal biological samples, and would take that intoconsideration when evaluating results.

The above-recited assay may also be useful in monitoring a disease ordisorder, where the level of IL-6 obtained in a biological sample from apatient believed to have an IL-6 associated disease or disorder iscompared with the level of IL-6 in prior biological samples from thesame patient, in order to ascertain whether the IL-6 level in saidpatient has changed with, for example, a treatment regimen. A skilledclinician would understand that a biological sample includes, but is notlimited to, sera, plasma, urine, saliva, mucous, pleural fluid, synovialfluid and spinal fluid.

The IL-6 antagonists described herein, including the anti-IL-6antibodies (e.g., Ab1 antibody) may be used in methods of studyingmucositis. For example, the IL-6 antagonists described herein, includingthe anti-IL-6 antibodies (e.g., Ab1 antibody), may be compared to othertherapeutic agents, both known and experimental, to test foreffectiveness in treating mucositis. See Bowen, et al. (2011) J SupportOncol. 9(5): 161-8.

Fusion Proteins

Fusion proteins comprising IL-6 antagonists are also provided by thepresent invention. Fusions comprising the anti-IL-6 antibodiespolypeptides are also within the scope of the present invention. Forexample, the fusion protein may be linked to a GST fusion protein inwhich the anti-IL-6 antibodies polypeptide sequences are fused to theC-terminus of the GST sequences. Such fusion proteins may facilitate thepurification of the recombinant Anti-IL-6 antibodies polypeptides.Alternatively, anti-IL-6 antibodies polypeptides may be fused with aprotein that binds B-cell follicles, thus initiating both a humoralimmune response and activation of T cells. Berney, et al. (1999) J. Exp.Med. 190: 851-60. Alternatively, for example, the Anti-IL-6 antibodiespolypeptides may be genetically coupled with and anti-dendritic cellantibody to deliver the antigen to the immune system and stimulate acellular immune response. He, et al. (2004) Clin. Cancer Res. 10:1920-27. A chimeric or fusion protein of the invention may be producedby standard recombinant DNA techniques. For example, DNA fragmentscoding for the different polypeptide sequences are ligated togetherin-frame in accordance with conventional techniques, e.g., by employingblunt-ended or stagger-ended termini for ligation, restriction enzymedigestion to provide for appropriate termini, filling-in of cohesiveends as appropriate, alkaline phosphatase treatment to avoid undesirablejoining, and enzymatic ligation. The fusion gene may be synthesized byconventional techniques including automated DNA synthesizers.

Fusion proteins may include C-terminal or N-terminal translocationsequences. Further, fusion proteins can comprise additional elements,e.g., for protein detection, purification, or other applications.Detection and purification facilitating domains including but notlimited to metal chelating peptides such as polyhistidine tracts,histidine-tryptophan modules, or other domains that allow purificationon immobilized metals; maltose binding protein; protein A domains thatallow purification on immobilized immunoglobulin; or the domain utilizedin the FLAG extension/affinity purification system (Immunex Corp,Seattle Wash.)

A fusion protein may be prepared from a protein of the invention byfusion with a portion of an immunoglobulin comprising a constant regionof an immunoglobulin. More preferably, the portion of the immunoglobulincomprises a heavy chain constant region which is optionally and morepreferably a human heavy chain constant region. The heavy chain constantregion is most preferably an IgG heavy chain constant region, andoptionally and most preferably is an Fc chain, most preferably an IgG Fcfragment that comprises CH2 and CH3 domains. Although any IgG subtypemay optionally be used, the IgG1 subtype is preferred. The Fc chain mayoptionally be a known or “wild type” Fc chain, or alternatively may bemutated. See, e.g., U.S. Patent Application Publication No.2006/0034852. The term “Fc chain” also optionally comprises any type ofFc fragment. Several of the specific amino acid residues that areinvolved in antibody constant region-mediated activity in the IgGsubclass have been identified. Inclusion, substitution or exclusion ofthese specific amino acids therefore allows for inclusion or exclusionof specific immunoglobulin constant region-mediated activity.Furthermore, specific changes may result in aglycosylation for exampleand/or other desired changes to the Fc chain. At least some changes mayoptionally be made to block a function of Fc which is considered to beundesirable, such as an undesirable immune system effect. SeeMcCafferty, et al. (2002) Antibody Engineering: A Practical Approach(Eds.) Oxford University Press.

The inclusion of a cleavable linker sequences such as Factor Xa (see,e.g., Ottavi, (1998) Biochimie 80: 289-93), subtilisin proteaserecognition motif (see, e.g., Polyak (1997) Protein Eng. 10: 615-19);enterokinase (Invitrogen, San Diego, Calif.), between the translocationdomain (for efficient plasma membrane expression) and the rest of thenewly translated polypeptide may be useful to facilitate purification.For example, one construct can include a polypeptide encoding a nucleicacid sequence linked to six histidine residues followed by athioredoxin, an enterokinase cleavage site (see, e.g., Williams (1995)Biochemistry 34: 1787-97), and an C-terminal translocation domain. Thehistidine residues facilitate detection and purification while theenterokinase cleavage site provides a means for purifying the desiredprotein(s) from the remainder of the fusion protein. Technologypertaining to vectors encoding fusion proteins and application of fusionproteins are well described in the art. See, e.g., Kroll (1993) DNACell. Biol. 12: 441-53.

Conjugates

IL-6 antagonists may be conjugated to other moieties (e.g., conjugates).Further, the anti-IL-6 antibodies, antibodies that bind the Anti-IL-6antibodies and fragments thereof, may be conjugated to other moieties.Such conjugates are often used in the preparation of vaccines. Theanti-IL-6 antibodies polypeptide may be conjugated to a carbohydrate(e.g., mannose, fucose, glucose, GlcNAs, maltose), which is recognizedby the mannose receptor present on dendritic cells and macrophages. Theensuing binding, aggregation, and receptor-mediated endocytosis andphagocytosis functions provide enhanced innate and adaptive immunity.See Mahnke, et al. (2000) J. Cell Biol. 151: 673-84; Dong, et al. (1999)J. Immonol. 163: 5427-34. Other moieties suitable for conjugation toelicit an immune response includes but not limited to Keyhole LimpitHemocyannin (KLH), diphtheria toxoid, cholera toxoid, Pseudomonasexoprotein A, and microbial outer membrane proteins (OMPS).

Labels

As stated above, antibodies and fragments and variants thereof may bemodified post-translationally to add effector moieties such as chemicallinkers, detectable moieties such as for example fluorescent dyes,enzymes, substrates, bioluminescent materials, radioactive materials,and chemiluminescent moieties, or functional moieties such as forexample streptavidin, avidin, biotin, a cytotoxin, a cytotoxic agent,and radioactive materials.

The anti-IL-6 antibodies and antibody fragments thereof described hereinmay be modified post-translationally to add effector moieties such aschemical linkers, detectable moieties such as for example fluorescentdyes, enzymes, substrates, bioluminescent materials, radioactivematerials, chemiluminescent moieties, a cytotoxic agent, radioactivematerials, or functional moieties.

A wide variety of entities, e.g., ligands, may be coupled to theoligonucleotides as known in the art. Ligands may include naturallyoccurring molecules, or recombinant or synthetic molecules. Exemplaryligands include, but are not limited to, avadin, biotin, peptides,peptidomimetics, polylysine (PLL), polyethylene glycol (PEG), mPEG,cationic groups, spermine, spermidine, polyamine, thyrotropin,melanotropin, lectin, glycoprotein, surfactant protein A, mucin,glycosylated polyaminoacids, transferrin, aptamer, immunoglobulins(e.g., antibodies), insulin, transferrin, albumin, sugar, lipophilicmolecules (e.g., steroids, bile acids, cholesterol, cholic acid, andfatty acids), vitamin A, vitamin E, vitamin K, vitamin B, folic acid,B12, riboflavin, biotin, pyridoxal, vitamin cofactors,lipopolysaccharide, hormones and hormone receptors, lectins,carbohydrates, multivalent carbohydrates, radiolabeled markers,fluorescent dyes, and derivatives thereof. See, e.g., U.S. Pat. Nos.6,153,737; 6,172,208; 6,300,319; 6,335,434; 6,335,437; 6,395,437;6,444,806; 6,486,308; 6,525,031; 6,528,631; and 6,559,279.

Additionally, moieties may be added to the antigen or epitope toincrease half-life in vivo (e.g., by lengthening the time to clearancefrom the blood stream. Such techniques include, for example, adding PEGmoieties (also termed pegilation), and are well-known in the art. SeeU.S. Patent Application Publication No. 2003/0031671.

An anti-IL-6 antibody or antigen binding fragment thereof, describedherein may be “attached” to a substrate when it is associated with thesolid label through a non-random chemical or physical interaction. Theattachment may be through a covalent bond. However, attachments need notbe covalent or permanent. Materials may be attached to a label through a“spacer molecule” or “linker group.” Such spacer molecules are moleculesthat have a first portion that attaches to the biological material and asecond portion that attaches to the label. Thus, when attached to thelabel, the spacer molecule separates the label and the biologicalmaterials, but is attached to both. Methods of attaching biologicalmaterial (e.g., label) to a label are well known in the art, and includebut are not limited to chemical coupling.

Detectable Labels

The anti-IL-6 antibody or antibody fragments described herein may bemodified post-translationally to add effector labels such as chemicallinkers, detectable labels such as for example fluorescent dyes,enzymes, substrates, bioluminescent materials, radioactive materials,and chemiluminescent labels, or functional labels such as for examplestreptavidin, avidin, biotin, a cytotoxin, a cytotoxic agent, andradioactive materials. Further exemplary enzymes include, but are notlimited to, horseradish peroxidase, acetylcholinesterase, alkalinephosphatase, β-galactosidase and luciferase. Further exemplaryfluorescent materials include, but are not limited to, rhodamine,fluorescein, fluorescein isothiocyanate, umbelliferone,dichlorotriazinylamine, phycoerythrin and dansyl chloride. Furtherexemplary chemiluminescent labels include, but are not limited to,luminol. Further exemplary bioluminescent materials include, but are notlimited to, luciferin and aequorin. Further exemplary radioactivematerials include, but are not limited to, bismuth-213 (²¹³Bs),carbon-14 (¹⁴C), carbon-11 (¹¹C), chlorine-18 (¹⁸Cl), chromium-51(⁵¹Cr), cobalt-57 (⁵⁷Co), cobalt-60 (⁶⁰Co), copper-64 (⁶⁴Cu), copper-67(⁶⁷Cu), dysprosium-165 (¹⁶⁵Dy), erbium-169 (¹⁶⁹Er), fluorine-18 (¹⁸F),gallium-67 (⁶⁷Ga), gallium-68 (⁶⁸Ga), germanium-68 (⁶⁸Ge), holmium-166(¹⁶⁶Ho), indium-111 (¹¹¹In), iodine-125 (¹²⁵I), iodine-123 (¹²⁴I),iodine-124 (¹²⁴I), iodine-131 (¹³¹I), iridium-192 (192Ir) iron-59(⁵⁹Fe), krypton-81 (⁸¹Kr), lead-212 (²¹²Pr) lutetium-177 (¹⁷⁷Lu),molybdenum-99 (⁹⁹Mo), nitrogen-13 (¹³N), oxygen-15 (¹⁵O), palladium-103(¹⁰³Pd), phosphorus-32 (³²P), potassium-42 (⁴²K), rhenium-186 (¹⁸⁶Re),rhenium-188 (¹⁸⁸Re), rubidium-81 (⁸¹Rb), rubidium-82 (⁸²Rb),samarium-153 (¹⁵³Sm), selenium-75 (⁷⁵Se), sodium-24 (²⁴Na), strontium-82(⁸²Sr), strontium-89 (⁸9Sr), sulfur 35 (³⁵S), technetium-99m (⁹⁹Tc),thallium-201 (²⁰¹Tl), tritium (³H), xenon-133 (¹³³Xe), ytterbium-169(¹⁶⁹Yb), ytterbium-177 (¹⁷⁷Yb), and yttrium-90 (⁹⁰Y).

Cytotoxic Agents

The anti-IL-6 antibodies and antibody fragments described herein may beconjugated to cytotoxic agents including, but are not limited to,methotrexate, aminopterin, 6-mercaptopurine, 6-thioguanine, cytarabine,5-fluorouracil decarbazine; alkylating agents such as mechlorethamine,thioepa chlorambucil, melphalan, carmustine (BSNU), mitomycin C,lomustine (CCNU), 1-methylnitrosourea, cyclothosphamide,mechlorethamine, busulfan, dibromomannitol, streptozotocin, mitomycin C,cis-dichlorodiamine platinum (II) (DDP) cisplatin and carboplatin(paraplatin); anthracyclines include daunorubicin (formerly daunomycin),doxorubicin (adriamycin), detorubicin, caminomycin, idarubicin,epirubicin, mitoxantrone and bisantrene; antibiotics includedactinomycin (actinomycin D), bleomycin, calicheamicin, mithramycin, andanthramycin (AMC); and antimytotic agents such as the vinca alkaloids,vincristine and vinblastine. Other cytotoxic agents include paclitaxel(TAXOL®), ricin, pseudomonas exotoxin, gemcitabine, cytochalasin B,gramicidin D, ethidium bromide, emetine, etoposide, tenoposide,colchicin, dihydroxy anthracin dione, 1-dehydrotestosterone,glucocorticoids, procaine, tetracaine, lidocaine, propranolol,puromycin, procarbazine, hydroxyurea, asparaginase, corticosteroids,mytotane (O,P′-(DDD)), interferons, and mixtures of these cytotoxicagents.

Further cytotoxic agents include, but are not limited to,chemotherapeutic agents such as carboplatin, cisplatin, paclitaxel,gemcitabine, calicheamicin, doxorubicin, 5-fluorouracil, mitomycin C,actinomycin D, cyclophosphamide, vincristine, bleomycin, VEGFantagonists, EGFR antagonists, platins, taxols, irinotecan,5-fluorouracil, gemcytabine, leucovorine, steroids, cyclophosphamide,melphalan, vinca alkaloids (e.g., vinblastine, vincristine, vindesineand vinorelbine), mustines, tyrosine kinase inhibitors, radiotherapy,sex hormone antagonists, selective androgen receptor modulators,selective estrogen receptor modulators, PDGF antagonists, TNFantagonists, IL-1 antagonists, interleukins (e.g. IL-12 or IL-2), IL-12Rantagonists, Erbitux®, Avastin®, Pertuzumab, anti-CD20 antibodies,Rituxan®, ocrelizumab, ofatumumab, DXL625, Herceptin®, or anycombination thereof. Toxic enzymes from plants and bacteria such asricin, diphtheria toxin and Pseudomonas toxin may be conjugated to thehumanized antibodies, or binding fragments thereof, to generatecell-type-specific-killing reagents. Youle, et al. (1980) Proc. Nat'lAcad. Sci. USA 77: 5483; Gilliland, et al. (1980) Proc. Nat'l Acad. Sci.USA 77: 4539; Krolick, et al. (1980) Proc. Nat'l Acad. Sci. USA 77:5419. Other cytotoxic agents include cytotoxic ribonucleases. See U.S.Pat. No. 6,653,104.

The anti-IL-6 antibodies and antibody fragments described herein may beconjugated to a radionuclide that emits alpha or beta particles (e.g.,radioimmunoconjuagtes). Such radioactive isotopes include but are notlimited to beta-emitters such as phosphorus-32 (³²P), scandium-47(⁴⁷Sc), copper-67 (⁶⁷Cu), gallium-67 (⁶⁷Ga), yttrium-88 (⁸⁸Y),yttrium-90 (⁹⁰Y), iodine-125 (¹²⁵I), iodine-131 (¹³¹I), samarium-153(¹⁵³Sm), lutetium-177 (¹⁷⁷Lu), rhenium-186 (¹⁸⁶Re), rhenium-188 (¹⁸⁸Re),and alpha-emitters such as astatine-211 (²¹¹At), lead-212 (²¹²Pb),bismuth-212 (²¹²Bi), bismuth-213 (²¹³Bi) or actinium-225 (²²⁵Ac).

Methods are known in the art for conjugating an anti-IL-6 antibodydescribed herein to a label, such as those methods described by Hunter,et al. (1962) Nature 144: 945; David, et al. (1974) Biochemistry 13:1014; Pain, et al. (1981) J. Immunol. Meth. 40: 219; and Nygren (1982)Histochem and Cytochem 30: 407.

Substrates

The anti-IL-6 antibodies and antibody fragments thereof described hereinmay be attached to a substrate. A number of substrates (e.g., solidsupports) known in the art are suitable for use with the anti-IL-6antibody described herein. The substrate may be modified to containchannels or other configurations. See Fung (2004) [Ed.] Protein Arrays:Methods and Protocols Humana Press and Kambhampati (2004) [Ed.] ProteinMicroarray Technology John Wiley & Sons.

Substrate materials include, but are not limited to acrylics, agarose,borosilicate glass, carbon (e.g., carbon nanofiber sheets or pellets),cellulose acetate, cellulose, ceramics, gels, glass (e.g., inorganic,controlled-pore, modified, soda-lime, or functionalized glass), latex,magnetic beads, membranes, metal, metalloids, nitrocellulose, NYLON®,optical fiber bundles, organic polymers, paper, plastics,polyacryloylmorpholide, poly(4-methylbutene), poly(ethyleneterephthalate), poly(vinyl butyrate), polyacrylamide, polybutylene,polycarbonate, polyethylene, polyethyleneglycol terephthalate,polyformaldehyde, polymethacrylate, polymethylmethacrylate,polypropylene, polysaccharides, polystyrene, polyurethanes,polyvinylacetate, polyvinylchloride, polyvinylidene difluoride (PVDF),polyvinylpyrrolidinone, rayon, resins, rubbers, semiconductor materials,Sepharose®, silica, silicon, styrene copolymers, TEFLON®, and variety ofother polymers.

Substrates need not be flat and can include any type of shape includingspherical shapes (e.g., beads) or cylindrical shapes (e.g., fibers).Materials attached to solid supports may be attached to any portion ofthe solid support (e.g., may be attached to an interior portion of aporous solid support material).

The substrate body may be in the form of a bead, box, column, cylinder,disc, dish (e.g., glass dish, PETRI dish), fiber, film, filter,microtiter plate (e.g., 96-well microtiter plate), multi-bladed stick,net, pellet, plate, ring, rod, roll, sheet, slide, stick, tray, tube, orvial. The substrate may be a singular discrete body (e.g., a singletube, a single bead), any number of a plurality of substrate bodies(e.g., a rack of 10 tubes, several beads), or combinations thereof(e.g., a tray comprises a plurality of microtiter plates, a columnfilled with beads, a microtiter plate filed with beads).

An anti-IL-6 antibody or antibody fragment thereof may be “attached” toa substrate when it is associated with the solid substrate through anon-random chemical or physical interaction. The attachment may bethrough a covalent bond. However, attachments need not be covalent orpermanent. Materials may be attached to a substrate through a “spacermolecule” or “linker group.” Such spacer molecules are molecules thathave a first portion that attaches to the biological material and asecond portion that attaches to the substrate. Thus, when attached tothe substrate, the spacer molecule separates the substrate and thebiological materials, but is attached to both. Methods of attachingbiological material (e.g., label) to a substrate are well known in theart, and include but are not limited to chemical coupling.

Plates, such as microtiter plates, which support and contain thesolid-phase for solid-phase synthetic reactions may be used. Microtiterplates may house beads that are used as the solid-phase. By “particle”or “microparticle” or “nanoparticle” or “bead” or “microbead” or“microsphere” herein is meant microparticulate matter having any of avariety of shapes or sizes. The shape may be generally spherical butneed not be spherical, being, for example, cylindrical or polyhedral. Aswill be appreciated by those in the art, the particles may comprise awide variety of materials depending on their use, including, but notlimited to, cross-linked starch, dextrans, cellulose, proteins, organicpolymers including styrene polymers such as polystyrene andmethylstyrene as well as other styrene co-polymers, plastics, glass,ceramics, acrylic polymers, magnetically responsive materials, colloids,thoriasol, carbon graphite, titanium dioxide, nylon, latex, and TEFLON®.See e.g., “Microsphere Detection Guide” from Bangs Laboratories,Fishers, Ind.

The anti-IL-6 antibody or antibody fragment may be attached to on any ofthe forms of substrates described herein (e.g., bead, box, column,cylinder, disc, dish (e.g., glass dish, PETRI dish), fiber, film,filter, microtiter plate (e.g., 96-well microtiter plate), multi-bladedstick, net, pellet, plate, ring, rod, roll, sheet, slide, stick, tray,tube, or vial). In particular, particles or beads may be a component ofa gelling material or may be separate components such as latex beadsmade of a variety of synthetic plastics (e.g., polystyrene). The label(e.g., streptavidin) may be bound to a substrate (e.g., bead).

Assessment of Inflammatory Markers

Known inflammatory markers (e.g., IL-6) may be measured to assess therisk for mucositis or the severity of mucositis. These markers may bemeasured from serum, synovial fluid, or skin biopsies using knownmethods in the art (e.g., immunoassays).

IL-6 Serum Levels

Serum IL-6 levels may be measured as a pharmacodynamic marker evaluatethe effect of neutralization of IL-6 levels. Serum IL-6 levels may bemeasured using an immunoassay (e.g., ELISA assay). A decrease of serumIL-6 levels may be indicative of a lessening of inflammation.

Serum Inflammatory Biomarkers

Serum biomarkers may be measured to determine the expression ofpro-inflammatory cytokines and other soluble biomarkers that maycorrelate with mucositis (e.g., oral, alimeniary, or gastrointestinaltract mucositis) disease activity including but not limited to acutephase reactants, serum pro-inflammatory cytokines (e.g., IL-1, TNF-α,IFN-γ, IL-12p40, IL-17), chemokines (e.g., RANTES, MIP-1α, MCP-1),matrix metalloproteinases (e.g., MMP-2, MMP-3, MMP-9) and otherbiomarkers associated with inflammation and autoimmune pathways that areknown in the art. Soluble biomarkers of bone and cartilage metabolism(e.g., osteocalcin and other collagen degradation products) may also beassessed by an immunoassay (e.g., ELISA). A decrease in a seruminflammatory biomark may be indicative of a lessening of inflammation.

Immunohistochemistry of Skin Biopsies

Skin biopsies may be collected for biomarker analysis including wholegenome array analysis and immunohistochemistry (IHC).Immunohistochemical analysis may include the measurement of epidermalthickness, frequency of resident and inflammatory cell populations(e.g., T cells, macrophages, keratinocytes) and other inflammatorymarkers related to the IL-6 pathway known in the art. Specifically, thefollowing specific antigens may be assessed per standard IHC procedureusing the formalin-fixed samples: CD3, CD68, keratin 16, FoxP3, IL-6Rand MMP-3. A decrease in an inflammatory biomarker in a skin biopsy maybe indicative of a lessening of inflammation.

Administration

In one embodiment of the invention, the anti-IL-6 antibodies describedherein, or IL-6 binding fragments or variants thereof, as well ascombinations of said antibody fragments or variants, are administered toa subject at a concentration of between about 0.1 and 20 mg/kg, such asabout 0.4 mg/kg, about 0.8 mg/kg, about 1.6 mg/kg, or about 4 mg/kg, ofbody weight of recipient subject. For example, compositions comprisingthe IL-6 antagonists described herein may comprise at least about 0, 10,20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170,180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310,320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450,460, 470, 480, 490, or 500 mg. For example, compositions comprising theanti-IL-6 antibodies described herein may comprise at least about 0, 10,20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170,180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310,320, 330, 340, 350, 360, 370, 380, 390, 400, 410, 420, 430, 440, 450,460, 470, 480, 490, or 500 mg.

For example, a composition for treating mucositis may comprise 80, 160,or 320 mg of an anti-IL-6 antibody (e.g., Ab1). A composition fortreating oral mucositis may comprise 80, 160, or 320 mg of an anti-IL-6antibody (e.g., Ab1). A composition for treating mucositis associatedwith chemotherapy may comprise 80, 160, or 320 mg of an anti-IL-6antibody (e.g., Ab1). A composition for treating oral mucositisassociated with chemotherapy may comprise 80, 160, or 320 mg of ananti-IL-6 antibody (e.g., Ab1). A composition for treating mucositisassociated with radiotherapy may comprise 80, 160, or 320 mg of ananti-IL-6 antibody (e.g., Ab1). A composition for treating oralmucositis associated with radiotherapy may comprise 80, 160, or 320 mgof an anti-IL-6 antibody (e.g., Ab1). A composition for treatingmucositis associated with cancer may comprise 80, 160, or 320 mg of ananti-IL-6 antibody (e.g., Ab1). A composition for treating oralmucositis associated with cancer may comprise 80, 160, or 320 mg of ananti-IL-6 antibody (e.g., Ab1). For example, compositions comprising theanti-IL-6 antibodies described herein may comprise at least about 0.5-10mg/kg of the anti-IL-6 antibody. In a preferred embodiment of theinvention, the anti-IL-6 antibodies described herein, or IL-6 bindingfragments or variants thereof, as well as combinations of said antibodyfragments or variants, are administered to a subject at a concentrationof about 0.4 mg/kg of body weight of recipient subject. In a preferredembodiment of the invention, the anti-IL-6 antibodies described herein,or IL-6 binding fragments or variants thereof, as well as combinationsof said antibody fragments or variants, are administered to a recipientsubject with a frequency of once every twenty-six weeks or less, such asonce every sixteen weeks or less, once every eight weeks or less, oronce every four weeks, or less. In another preferred embodiment of theinvention, the anti-IL-6 antibodies described herein, or IL-6 bindingfragments or variants thereof, as well as combinations thereof, areadministered to a recipient subject with a frequency at most once perperiod of approximately one week, such as at most once per period ofapproximately two weeks, such as at most once per period ofapproximately four weeks, such as at most once per period ofapproximately eight weeks, such as at most once per period ofapproximately twelve weeks, such as at most once per period ofapproximately sixteen weeks, such as at most once per period ofapproximately twenty-four weeks.

The compositions described herein may be administered in any of thefollowing routes: buccal, epicutaneous, epidural, infusion, inhalation,intraarterial, intracardial, intracerebroventricular, intradermal,intramuscular, intranasal, intraocular, intraperitoneal, intraspinal,intrathecal, intravenous, oral, parenteral, pulmonary, rectally via anenema or suppository, subcutaneous, subdermal, sublingual, transdermal,and transmucosal. The preferred routes of administration are intravenousinjection or infusion. The administration can be local, where thecomposition is administered directly, close to, in the locality, near,at, about, or in the vicinity of, the site(s) of disease, e.g., local(joint) or systemic, wherein the composition is given to the patient andpasses through the body widely, thereby reaching the site(s) of disease.Local administration (e.g., subcutaneous injection) may be accomplishedby administration to the cell, tissue, organ, and/or organ system, whichencompasses and/or is affected by the disease, and/or where the diseasesigns and/or symptoms are active or are likely to occur (e.g., swollenjoint). Administration can be topical with a local effect, compositionis applied directly where its action is desired (e.g., joint). Further,administration of a composition comprising an effective amount of ananti-IL-6 antibody selected from the group consisting of Ab1-Ab36 or anantibody fragment thereof, may be subcutaneous.

For each of the recited embodiments, the compounds can be administeredby a variety of dosage forms as known in the art. Anybiologically-acceptable dosage form known to persons of ordinary skillin the art, and combinations thereof, are contemplated. Examples of suchdosage forms include, without limitation, chewable tablets, quickdissolve tablets, effervescent tablets, reconstitutable powders,elixirs, liquids, solutions, suspensions, emulsions, tablets,multi-layer tablets, bi-layer tablets, capsules, soft gelatin capsules,hard gelatin capsules, caplets, lozenges, chewable lozenges, beads,powders, gum, granules, particles, microparticles, dispersible granules,cachets, douches, suppositories, creams, topicals, inhalants, aerosolinhalants, patches, particle inhalants, implants, depot implants,ingestibles, injectables (including subcutaneous, intramuscular,intravenous, and intradermal), infusions, and combinations thereof.

Other compounds which can be included by admixture are, for example,medically inert ingredients (e.g., solid and liquid diluent), such aslactose, dextrosesaccharose, cellulose, starch or calcium phosphate fortablets or capsules, olive oil or ethyl oleate for soft capsules andwater or vegetable oil for suspensions or emulsions; lubricating agentssuch as silica, talc, stearic acid, magnesium or calcium stearate and/orpolyethylene glycols; gelling agents such as colloidal clays; thickeningagents such as gum tragacanth or sodium alginate, binding agents such asstarches, arabic gums, gelatin, methylcellulose, carboxymethylcelluloseor polyvinylpyrrolidone; disintegrating agents such as starch, alginicacid, alginates or sodium starch glycolate; effervescing mixtures;dyestuff; sweeteners; wetting agents such as lecithin, polysorbates orlaurylsulphates; and other therapeutically acceptable accessoryingredients, such as humectants, preservatives, buffers andantioxidants, which are known additives for such formulations.

Liquid dispersions for oral administration can be syrups, emulsions,solutions, or suspensions. The syrups can contain as a carrier, forexample, saccharose or saccharose with glycerol and/or mannitol and/orsorbitol. The suspensions and the emulsions can contain a carrier, forexample a natural gum, agar, sodium alginate, pectin, methylcellulose,carboxymethylcellulose, or polyvinyl alcohol.

In further embodiments, the present invention provides kits including atleast one containers comprising pharmaceutical dosage units comprisingan effective amount of at least one antibodies and fragments thereof ofthe present invention. Kits may include instructions, directions,labels, marketing information, warnings, or information pamphlets.

Dosages

The amount of anti-IL-6 antibodies in a therapeutic compositionaccording to any embodiments of this invention may vary according tofactors such as the disease state, age, gender, weight, patient history,risk factors, predisposition to disease, administration route,preexisting treatment regime (e.g., possible interactions with othermedications), and weight of the individual. Dosage regimens may beadjusted to provide the optimum therapeutic response. For example, asingle bolus may be administered, several divided doses may beadministered over time, or the dose may be proportionally reduced orincreased as indicated by the exigencies of therapeutic situation.

For example, for the treatment of mucositis (e.g., oral, esophageal,alimentary, and gastrointestinal tract mucositis) a composition maycomprise at least about 80, 160, or 320 mg IL-6 antagonists may beadministered to a patient in need thereof. In another embodiment, forthe treatment of oral mucositis a composition may comprise at leastabout 80, 160, or 320 mg IL-6 antagonists may be administered to apatient in need thereof. Further, for the treatment of mucositis acomposition may comprise at least about 80, 160, or 320 mg anti-IL-6antibody (e.g., Ab1) may be administered to a patient in need thereof.In another embodiment, for the treatment of oral mucositis a compositionmay comprise at least about 80, 160, or 320 mg anti-IL-6 antibody (e.g.,Ab1) may be administered to a patient in need thereof. The dosage ofIL-6 antagonist, may depend upon the mode of administration. Forexample, for subcutaneous administration of a composition may comprisean IL-6 antagonist, the composition may comprise at least about 1-500mg/mL, 10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL of an IL-antagonist.For example, a composition for subcutaneous administration may compriseat least about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of anIL-6 antagonist. Thus, a composition for subcutaneous administration maycomprise at least about at least about 1-500 mg/mL, 10-250 mg/mL, 10-100mg/mL, or 40-100 mg/mL of an anti-IL-6 antibody (e.g., Ab1). or at leastabout 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of an anti-IL-6antibody (e.g., Ab1). For intravenous administration of a compositionmay comprise an IL-6 antagonist, the composition may comprise at leastabout 1-500 mg/mL, 10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL of anIL-antagonist. For example, a composition for intravenous administrationmay comprise at least about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100mg/mL of an IL-6 antagonist. Thus, a composition for intravenousadministration may comprise at least about at least about 1-500 mg/mL,10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL of an anti-IL-6 antibody(e.g., Ab1) or at least about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100mg/mL of an anti-IL-6 antibody (e.g., Ab1). The mucositis may beassociated with chemotherapy, radiotherapy, cancer, or hematopoieticstem cell transplants. For example, the oral mucositis may be associatedwith chemotherapy, radiotherapy, cancer, or hematopoietic stem celltransplants.

For example, a composition for the treatment of alimentary tractmucositis may comprise at least about 80, 160, or 320 mg IL-6antagonists may be administered to a patient in need thereof. Further, acomposition for the treatment of alimentary tract mucositis may compriseat least about 80, 160, or 320 mg anti-IL-6 antibody (e.g., Ab1) may beadministered to a patient in need thereof. For example, a compositionfor the treatment of alimentary tract mucositis formulated forsubcutaneous administration may comprise at least about 10, 20, 30, 40,50, 60, 70, 80, 90, or 100 mg/mL of an IL-6 antagonist. Thus, acomposition for the treatment of alimentary tract mucositis formulatedfor subcutaneous administration may comprise at least about at leastabout 1-500 mg/mL, 10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL of ananti-IL-6 antibody (e.g., Ab1) or at least about 10, 20, 30, 40, 50, 60,70, 80, 90, or 100 mg/mL of an anti-IL-6 antibody (e.g., Ab1). Acomposition for the treatment of alimentary tract mucositis formulatedfor intravenous administration may comprise at least about 10, 20, 30,40, 50, 60, 70, 80, 90, or 100 mg/mL of an IL-6 antagonist. Thus, acomposition for the treatment of alimentary tract mucositis formulatedfor intravenous administration may comprise at least about at leastabout 1-500 mg/mL, 10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL of ananti-IL-6 antibody (e.g., Ab1) or at least about 10, 20, 30, 40, 50, 60,70, 80, 90, or 100 mg/mL of an anti-IL-6 antibody (e.g., Ab1). Thealimentary tract mucositis may be associated with chemotherapy,radiotherapy, cancer, or hematopoietic stem cell transplants.

For example, a composition for the treatment of gastrointestinal tractmucositis may comprise at least about 80, 160, or 320 mg IL-6antagonists may be administered to a patient in need thereof. Further, acomposition for the treatment of gastrointestinal tract mucositis maycomprise at least about 80, 160, or 320 mg anti-IL-6 antibody (e.g.,Ab1) may be administered to a patient in need thereof. For example, acomposition for the treatment of gastrointestinal tract mucositisformulated for subcutaneous administration may comprise at least about10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of an IL-6 antagonist.Thus, a composition for the treatment of gastrointestinal tractmucositis formulated for subcutaneous administration may comprise atleast about at least about 1-500 mg/mL, 10-250 mg/mL, 10-100 mg/mL, or40-100 mg/mL of an anti-IL-6 antibody (e.g., Ab1) or at least about 10,20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of an anti-IL-6 antibody(e.g., Ab1). A composition for the treatment of gastrointestinal tractmucositis formulated for intravenous administration may comprise atleast about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of an IL-6antagonist. Thus, a composition for the treatment of gastrointestinaltract mucositis formulated for intravenous administration may compriseat least about at least about 1-500 mg/mL, 10-250 mg/mL, 10-100 mg/mL,or 40-100 mg/mL of an anti-IL-6 antibody (e.g., Ab1) or at least about10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of an anti-IL-6antibody (e.g., Ab1). The gastrointestinal tract mucositis may beassociated with chemotherapy, radiotherapy, cancer, or hematopoieticstem cell transplants.

Further, an intravenous formulation of an Ab1 anti-IL-6 antibody maycomprise at least about 10 mg/mL or 40 mg/L for the treatment ofrheumatoid arthritis and a subcutaneous formulation of an Ab1 anti-IL-6antibody may comprise at least about 100 mg/mL for the treatment ofrheumatoid arthritis. For example, a composition for the treatment ofrheumatoid arthritis formulated for subcutaneous administration maycomprise at least about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mLof an IL-6 antagonist. Thus, a composition for the treatment ofrheumatoid arthritis formulated for subcutaneous administration maycomprise at least about at least about 1-500 mg/mL, 10-250 mg/mL, 10-100mg/mL, or 40-100 mg/mL of an anti-IL-6 antibody (e.g., Ab1) or at leastabout 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of an anti-IL-6antibody (e.g., Ab1). A composition for the treatment of rheumatoidarthritis formulated for intravenous administration may comprise atleast about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of an IL-6antagonist. Thus, a composition for the treatment of rheumatoidarthritis formulated for intravenous administration may comprise atleast about at least about 1-500 mg/mL, 10-250 mg/mL, 10-100 mg/mL, or40-100 mg/mL of an anti-IL-6 antibody (e.g., Ab1) or at least about 10,20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mL of an anti-IL-6 antibody(e.g., Ab1). The rheumatoid arthritis may be associated withchemotherapy, radiotherapy, cancer, or hematopoietic stem celltransplants.

For example, a composition for the treatment of emesis may comprise atleast about 80, 160, or 320 mg IL-6 antagonists may be administered to apatient in need thereof. Further, a composition for the treatment ofemesis may comprise at least about 80, 160, or 320 mg anti-IL-6 antibody(e.g., Ab1) may be administered to a patient in need thereof. Forexample, a composition for the treatment of emesis formulated forsubcutaneous administration may comprise at least about 10, 20, 30, 40,50, 60, 70, 80, 90, or 100 mg/mL of an IL-6 antagonist. Thus, acomposition for the treatment of emesis formulated for subcutaneousadministration may comprise at least about at least about 1-500 mg/mL,10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL of an anti-IL-6 antibody(e.g., Ab1) or at least about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100mg/mL of an anti-IL-6 antibody (e.g., Ab1). A composition for thetreatment of emesis formulated for intravenous administration maycomprise at least about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mLof an IL-6 antagonist. Thus, a composition for the treatment of emesisformulated for intravenous administration may comprise at least about atleast about 1-500 mg/mL, 10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL ofan anti-IL-6 antibody (e.g., Ab1) or at least about 10, 20, 30, 40, 50,60, 70, 80, 90, or 100 mg/mL of an anti-IL-6 antibody (e.g., Ab1). Theemesis may be associated with chemotherapy, radiotherapy, cancer, orhematopoietic stem cell transplants.

For example, a composition for the treatment of diarrhea may comprise atleast about 80, 160, or 320 mg IL-6 antagonists may be administered to apatient in need thereof. Further, a composition for the treatment ofemesis may comprise at least about 80, 160, or 320 mg anti-IL-6 antibody(e.g., Ab1) may be administered to a patient in need thereof. Forexample, a composition for the treatment of diarrhea formulated forsubcutaneous administration may comprise at least about 10, 20, 30, 40,50, 60, 70, 80, 90, or 100 mg/mL of an IL-6 antagonist. Thus, acomposition for the treatment of diarrhea formulated for subcutaneousadministration may comprise at least about at least about 1-500 mg/mL,10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL of an anti-IL-6 antibody(e.g., Ab1) or at least about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100mg/mL of an anti-IL-6 antibody (e.g., Ab1). A composition for thetreatment of diarrhea formulated for intravenous administration maycomprise at least about 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mg/mLof an IL-6 antagonist. Thus, a composition for the treatment of diarrheaformulated for intravenous administration may comprise at least about atleast about 1-500 mg/mL, 10-250 mg/mL, 10-100 mg/mL, or 40-100 mg/mL ofan anti-IL-6 antibody (e.g., Ab1) or at least about 10, 20, 30, 40, 50,60, 70, 80, 90, or 100 mg/mL of an anti-IL-6 antibody (e.g., Ab1). Thediarrhea may be associated with chemotherapy, radiotherapy, cancer, orhematopoietic stem cell transplants.

It is especially advantageous to formulate parenteral compositions indosage unit form for ease of administration and uniformity of dosage.Dosage unit form as used herein refers to physically discrete unitssuited as unitary dosages for the mammalian subjects to be treated; eachunit containing a predetermined quantity of antibodies, or antibodyfragments thereof, calculated to produce the desired therapeutic effectin association with the required pharmaceutical carrier. Thespecification for the dosage unit forms of the invention are dictated byand directly dependent on the unique characteristics of the antibodies,and fragments thereof, and the particular therapeutic effect to beachieved, and the limitations inherent in the art of compounding such anantibodies, and fragments thereof, for the treatment of sensitivity inindividuals. In therapeutic use for treatment of conditions in mammals(e.g., humans) for which the antibodies and fragments thereof of thepresent invention or an appropriate pharmaceutical composition thereofare effective, the antibodies and fragments thereof of the presentinvention may be administered in an effective amount. The dosages assuitable for this invention may be a composition, a pharmaceuticalcomposition or any other compositions described herein.

The dosage may be administered as a single dose, a double dose, a tripledose, a quadruple dose, and/or a quintuple dose. The dosages may beadministered singularly, simultaneously, and sequentially. For example,two doses may be administered on the same day followed by subsequent twodoses four weeks later.

The dosage form may be any form of release known to persons of ordinaryskill in the art. The compositions of the present invention may beformulated to provide immediate release of the active ingredient orsustained or controlled release of the active ingredient. In a sustainedrelease or controlled release preparation, release of the activeingredient may occur at a rate such that blood levels are maintainedwithin a therapeutic range but below toxic levels over an extendedperiod of time (e.g., 4 to 24 hours). The preferred dosage forms includeimmediate release, extended release, pulse release, variable release,controlled release, timed release, sustained release, delayed release,long acting, and combinations thereof, and are known in the art.

It will be appreciated that the pharmacological activity of thecompositions may be monitored using standard pharmacological models thatare known in the art. Furthermore, it will be appreciated that thecompositions comprising an anti-IL-6 antibodies or antibody fragmentsthereof may be incorporated or encapsulated in a suitable polymer matrixor membrane for site-specific delivery, or may be functionalized withspecific targeting agents capable of effecting site specific delivery.These techniques, as well as other drug delivery techniques are wellknown in the art. Determination of optimal dosages for a particularsituation is within the capabilities of those skilled in the art. See,e.g., Grennaro (2005) [Ed.] Remington: The Science and Practice ofPharmacy [21^(st) Ed.]

In another embodiment of the invention, the anti-IL-6 antibodiesdescribed herein, or IL-6 binding fragments or variants thereof, as wellas combinations of said antibody fragments or variants, are administeredto a subject in a pharmaceutical formulation.

A “pharmaceutical composition” refers to a chemical or biologicalcomposition suitable for administration to a mammal. Such compositionsmay be specifically formulated for administration via at least one of anumber of routes, including but not limited to buccal, epicutaneous,epidural, inhalation, intraarterial, intracardial,intracerebroventricular, intradermal, intramuscular, intranasal,intraocular, intraperitoneal, intraspinal, intrathecal, intravenous,oral, parenteral, rectally via an enema or suppository, subcutaneous,subdermal, sublingual, transdermal, and transmucosal. In addition,administration can occur by means of injection, powder, liquid, gel,drops, or other means of administration. Further, a pharmaceuticalcomposition comprising an anti-IL-6 antibody described herein (e.g.,ALD518) may be administered subcutaneously.

In one embodiment of the invention, the anti-IL-6 antibodies describedherein, or IL-6 binding fragments or variants thereof, as well ascombinations of said antibody fragments or variants, may be optionallyadministered in combination with at least one active agents. Such activeagents include analgesic, antipyretic, anti-inflammatory, antibiotic,antiviral, and anti-cytokine agents. Active agents include agonists,antagonists, and modulators of TNF-alpha, IL-2, IL-4, IL-6, IL-10,IL-12, IL-13, IL-18, IFN-alpha, IFN-gamma, BAFF, CXCL13, IP-10, VEGF,EPO, EGF, HRG, Hepatocyte Growth Factor (HGF), Hepcidin, includingantibodies reactive against any of the foregoing, and antibodiesreactive against any of their receptors. Active agents also include2-Arylpropionic acids, Aceclofenac, Acemetacin, Acetylsalicylic acid(Aspirin), Alclofenac, Alminoprofen, Amoxiprin, Ampyrone, Arylalkanoicacids, Azapropazone, Benorylate/Benorilate, Benoxaprofen, Bromfenac,Carprofen, Celecoxib, Choline magnesium salicylate, Clofezone, COX-2inhibitors, Dexibuprofen, Dexketoprofen, Diclofenac, Diflunisal,Droxicam, Ethenzamide, Etodolac, Etoricoxib, Faislamine, fenamic acids,Fenbufen, Fenoprofen, Flufenamic acid, Flunoxaprofen, Flurbiprofen,Ibuprofen, Ibuproxam, Indometacin, Indoprofen, Kebuzone, Ketoprofen,Ketorolac, Lornoxicam, Loxoprofen, Lumiracoxib, Magnesium salicylate,Meclofenamic acid, Mefenamic acid, Meloxicam, Metamizole, Methylsalicylate, Mofebutazone, Nabumetone, Naproxen, N-Arylanthranilic acids,Oxametacin, Oxaprozin, Oxicams, Oxyphenbutazone, Parecoxib, Phenazone,Phenylbutazone, Phenylbutazone, Piroxicam, Pirprofen, profens,Proglumetacin, Pyrazolidine derivatives, Rofecoxib, Salicyl salicylate,Salicylamide, Salicylates, Sulfinpyrazone, Sulindac, Suprofen,Tenoxicam, Tiaprofenic acid, Tolfenamic acid, Tolmetin, and Valdecoxib.Antibiotics include Amikacin, Aminoglycosides, Amoxicillin, Ampicillin,Ansamycins, Arsphenamine, Azithromycin, Azlocillin, Aztreonam,Bacitracin, Carbacephem, Carbapenems, Carbenicillin, Cefaclor,Cefadroxil, Cefalexin, Cefalothin, Cefalotin, Cefamandole, Cefazolin,Cefdinir, Cefditoren, Cefepime, Cefixime, Cefoperazone, Cefotaxime,Cefoxitin, Cefpodoxime, Cefprozil, Ceftazidime, Ceftibuten, Ceftizoxime,Ceftobiprole, Ceftriaxone, Cefuroxime, Cephalosporins, Chloramphenicol,Cilastatin, Ciprofloxacin, Clarithromycin, Clindamycin, Cloxacillin,Colistin, Co-trimoxazole, Dalfopristin, Demeclocycline, Dicloxacillin,Dirithromycin, Doripenem, Doxycycline, Enoxacin, Ertapenem,Erythromycin, Ethambutol, Flucloxacillin, Fosfomycin, Furazolidone,Fusidic acid, Gatifloxacin, Geldanamycin, Gentamicin, Glycopeptides,Herbimycin, Imipenem, Isoniazid, Kanamycin, Levofloxacin, Lincomycin,Linezolid, Lomefloxacin, Loracarbef, Macrolides, Mafenide, Meropenem,Meticillin, Metronidazole, Mezlocillin, Minocycline, Monobactams,Moxifloxacin, Mupirocin, Nafcillin, Neomycin, Netilmicin,Nitrofurantoin, Norfloxacin, Ofloxacin, Oxacillin, Oxytetracycline,Paromomycin, Penicillin, Penicillins, Piperacillin, Platensimycin,Polymyxin B, Polypeptides, Prontosil, Pyrazinamide, Quinolones,Quinupristin, Rifampicin, Rifampin, Roxithromycin, Spectinomycin,Streptomycin, Sulfacetamide, Sulfamethizole, Sulfanilimide,Sulfasalazine, Sulfisoxazole, Sulfonamides, Teicoplanin, Telithromycin,Tetracycline, Tetracyclines, Ticarcillin, Timidazole, Tobramycin,Trimethoprim, Trimethoprim-Sulfamethoxazole, Troleandomycin,Trovafloxacin, and Vancomycin. Active agents also include Aldosterone,Beclometasone, Betamethasone, Corticosteroids, Cortisol, Cortisoneacetate, Deoxycorticosterone acetate, Dexamethasone, Fludrocortisoneacetate, Glucocorticoids, Hydrocortisone, Methylprednisolone,Prednisolone, Prednisone, Steroids, and Triamcinolone. Antiviral agentsinclude but are not limited to abacavir, aciclovir, acyclovir, adefovir,amantadine, amprenavir, an antiretroviral fixed dose combination, anantiretroviral synergistic enhancer, arbidol, atazanavir, atripla,brivudine, cidofovir, combivir, darunavir, delavirdine, didanosine,docosanol, edoxudine, efavirenz, emtricitabine, enfuvirtide, entecavir,entry inhibitors, famciclovir, fomivirsen, fosamprenavir, foscarnet,fosfonet, fusion inhibitor, ganciclovir, gardasil, ibacitabine,idoxuridine, imiquimod, immunovir, indinavir, inosine, integraseinhibitor, interferon, interferon type I, interferon type II, interferontype III, lamivudine, lopinavir, loviride, maraviroc, MK-0518,moroxydine, nelfinavir, nevirapine, nexavir, nucleoside analogues,oseltamivir, penciclovir, peramivir, pleconaril, podophyllotoxin,protease inhibitor, reverse transcriptase inhibitor, ribavirin,rimantadine, ritonavir, saquinavir, stavudine, tenofovir, tenofovirdisoproxil, tipranavir, trifluridine, trizivir, tromantadine, truvada,valaciclovir, valganciclovir, vicriviroc, vidarabine, viramidine,zalcitabine, zanamivir, and zidovudine. Any suitable combination ofthese active agents is also contemplated.

A “pharmaceutical excipient” or a “pharmaceutically acceptableexcipient” is a carrier, usually a liquid, in which an activetherapeutic agent is formulated. In one embodiment of the invention, theactive therapeutic agent is a humanized antibody described herein, or atleast one fragments or variants thereof. The excipient generally doesnot provide any pharmacological activity to the formulation, though itmay provide chemical and/or biological stability, and releasecharacteristics. Exemplary formulations can be found, for example, inGrennaro (2005) [Ed.] Remington: The Science and Practice of Pharmacy[21^(st) Ed.]

As used herein “pharmaceutically acceptable carrier” or “excipient”includes any and all solvents, dispersion media, coatings, antibacterialand antifungal agents, isotonic and absorption delaying agents that arephysiologically compatible. In one embodiment, the carrier is suitablefor parenteral administration. Alternatively, the carrier can besuitable for intravenous, intraperitoneal, intramuscular, or sublingualadministration. Pharmaceutically acceptable carriers include sterileaqueous solutions or dispersions and sterile powders for theextemporaneous preparation of sterile injectable solutions ordispersions. The use of such media and agents for pharmaceuticallyactive substances is well known in the art. Except insofar as anyconventional media or agent is incompatible with the active compound,use thereof in the pharmaceutical compositions of the invention iscontemplated. Supplementary active compounds can also be incorporatedinto the compositions.

Pharmaceutical compositions typically must be sterile and stable underthe conditions of manufacture and storage. The invention contemplatesthat the pharmaceutical composition is present in lyophilized form. Thecomposition may be formulated as a solution, microemulsion, liposome, orother ordered structure suitable to high drug concentration. The carriermay be a solvent or dispersion medium containing, for example, water,ethanol, polyol (for example, glycerol, propylene glycol, and liquidpolyethylene glycol), and suitable mixtures thereof. The inventionfurther contemplates the inclusion of a stabilizer in the pharmaceuticalcomposition.

The antibodies and fragments thereof, of the present invention thereofmay be formulated into pharmaceutical compositions of various dosageforms. For example, the antibody may be ALD518, a humanizedanti-interleukin-6 (anti-IL-6) monoclonal immunoglobulin 1 (IgG1)antibody manufactured in the yeast Pichia pastoris. ALD518 may besupplied as a pH 6.0 frozen injection in single-use vials (80 mg or 160mg) for intravenous administration. Examplary non-active excipientsinclude but are not limited to histidine (e.g., 25 mM) and sorbitol(e.g., 250 mM). For example, a 160 mg formulation may comprise asnon-active excipients, 25 mM histidine, 250 mM sorbitol, and 0.015%polysorbate 80. To prepare the pharmaceutical compositions of theinvention, at least one anti-IL-6 antibodies or binding fragmentsthereof, as the active ingredient may be intimately mixed withappropriate carriers and additives according to techniques well known tothose skilled in the art of pharmaceutical formulations. See Grennaro(2005) [Ed.] Remington: The Science and Practice of Pharmacy [21^(st)Ed.] For example, the antibodies described herein may be formulated inphosphate buffered saline pH 7.2 and supplied as a 5.0 mg/mL clearcolorless liquid solution.

Similarly, compositions for liquid preparations include solutions,emulsions, dispersions, suspensions, syrups, and elixirs, with suitablecarriers and additives including but not limited to water, alcohols,oils, glycols, preservatives, flavoring agents, coloring agents, andsuspending agents. Typical preparations for parenteral administrationcomprise the active ingredient with a carrier such as sterile water orparenterally acceptable oil including but not limited to polyethyleneglycol, polyvinyl pyrrolidone, lecithin, arachis oil or sesame oil, withother additives for aiding solubility or preservation may also beincluded. In the case of a solution, it may be lyophilized to a powderand then reconstituted immediately prior to use. For dispersions andsuspensions, appropriate carriers and additives include aqueous gums,celluloses, silicates, or oils.

For each of the recited embodiments, the anti-IL-6 antibodies or bindingfragments thereof, may be administered by a variety of dosage forms. Anybiologically-acceptable dosage form known to persons of ordinary skillin the art, and combinations thereof, are contemplated. Examples of suchdosage forms include, without limitation, reconstitutable powders,elixirs, liquids, solutions, suspensions, emulsions, powders, granules,particles, microparticles, dispersible granules, cachets, inhalants,aerosol inhalants, patches, particle inhalants, implants, depotimplants, injectables (including subcutaneous, intramuscular,intravenous, and intradermal), infusions, and combinations thereof.

In many cases, it will be preferable to include isotonic agents, e.g.,sugars, polyalcohols such as mannitol, sorbitol, or sodium chloride inthe composition. Prolonged absorption of the injectable compositions maybe brought about by including in the composition an agent which delaysabsorption, e.g., monostearate salts and gelatin. Moreover, thecompounds described herein may be formulated in a time releaseformulation, e.g. in a composition that includes a slow release polymer.The anti-IL-6 antibodies may be prepared with carriers that will protectthe compound against rapid release, such as a controlled releaseformulation, including implants and microencapsulated delivery systems.Biodegradable, biocompatible polymers may be used, such as ethylenevinyl acetate, polyanhydrides, polyglycolic acid, collagen,polyorthoesters, polylactic acid and polylactic, polyglycolic copolymers(PLG). Many methods for the preparation of such formulations are knownto those skilled in the art.

In one embodiment of the invention that may be used to intravenouslyadminister antibodies of the invention, including ALD518, for mucositisindications, the administration formulation comprises, or alternativelyconsists of, about 10.5 mg/mL of antibody, 25 mM Histidine base,Phosphoric acid q.s. to pH 6, and 250 mM sorbitol.

In another embodiment of the invention that may be used to intravenouslyadminister antibodies of the invention, including ALD581, for mucositisindications, the administration formulation comprises, or alternativelyconsists of, about 10.5 mg/mL of antibody, 12.5 mM Histidine base, 12.5mM Histidine HCl (or 25 mM Histidine base and Hydrochloric acid q.s. topH 6), 250 mM sorbitol, and 0.015% (w/w) Polysorbate 80.

In one embodiment of the invention that may be used to subcutaneouslyadminister antibodies of the invention, including ALD518, for mucositisindications, the administration formulation comprises, or alternativelyconsists of, about 50 or 100 mg/mL of antibody, about 5 mM Histidinebase, about 5 mM Histidine HCl to make final pH 6, 250 mM sorbitol, and0.015% (w/w) Polysorbate 80. In another embodiment of the invention thatmay be used to subcutaneously administer antibodies of the invention,including Ab1, for mucositis indications, the administration formulationcomprises, or alternatively consists of, about 20 or 100 mg/mL ofantibody, about 5 mM Histidine base, about 5 mM Histidine HCl to makefinal pH 6, 250 to 280 mM sorbitol (or sorbitol in combination withsucrose), and 0.015% (w/w) Polysorbate 80, said formulation having anitrogen headspace in the shipping vials.

Pharmaceutical compositions typically must be sterile and stable underthe conditions of manufacture and storage. The invention contemplatesthat the pharmaceutical composition is present in lyophilized form. Thecomposition can be formulated as a solution, microemulsion, liposome, orother ordered structure suitable to high drug concentration. The carriercan be a solvent or dispersion medium containing, for example, water,ethanol, polyol (for example, glycerol, propylene glycol, and liquidpolyethylene glycol), and suitable mixtures thereof. The inventionfurther contemplates the inclusion of a stabilizer in the pharmaceuticalcomposition.

In many cases, it will be preferable to include isotonic agents, forexample, sugars, polyalcohols such as mannitol, sorbitol, or sodiumchloride in the composition. Prolonged absorption of the injectablecompositions can be brought about by including in the composition anagent which delays absorption, for example, monostearate salts andgelatin. Moreover, the alkaline polypeptide can be formulated in a timerelease formulation, for example in a composition which includes a slowrelease polymer. The active compounds can be prepared with carriers thatwill protect the compound against rapid release, such as a controlledrelease formulation, including implants and microencapsulated deliverysystems. Biodegradable, biocompatible polymers can be used, such asethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen,polyorthoesters, polylactic acid and polylactic, polyglycolic copolymers(PLG). Many methods for the preparation of such formulations are knownto those skilled in the art.

For each of the recited embodiments, the compounds can be administeredby a variety of dosage forms. Any biologically-acceptable dosage formknown to persons of ordinary skill in the art, and combinations thereof,are contemplated. Examples of such dosage forms include, withoutlimitation, reconstitutable powders, elixirs, liquids, solutions,suspensions, emulsions, powders, granules, particles, microparticles,dispersible granules, cachets, inhalants, aerosol inhalants, patches,particle inhalants, implants, depot implants, injectables (includingsubcutaneous, intramuscular, intravenous, and intradermal), infusions,and combinations thereof.

A person of skill in the art would be able to determine an effectivedosage and frequency of administration through routine experimentation,for example guided by the disclosure herein and the teachings inGoodman, et al. (2011) Goodman & Gilman's The Pharmacological Basis ofTherapeutics [12^(th) Ed.]; Howland, et al. (2005) Lippincott'sIllustrated Reviews: Pharmacology [2^(nd) Ed.]; and Golan, (2008)Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy[2^(nd) Ed.] See, also, Grennaro (2005) [Ed.] Remington: The Science andPractice of Pharmacy [21^(st) Ed.]

The above description of various illustrated embodiments of theinvention is not intended to be exhaustive or to limit the invention tothe precise form disclosed. While specific embodiments of, and examplesfor, the invention are described herein for illustrative purposes,various equivalent modifications are possible within the scope of theinvention, as those skilled in the relevant art will recognize. Theteachings provided herein of the invention can be applied to otherpurposes, other than the examples described above.

These and other changes can be made to the invention in light of theabove detailed description. In general, in the following claims, theterms used should not be construed to limit the invention to thespecific embodiments disclosed in the specification and the claims.Accordingly, the invention is not limited by the disclosure, but insteadthe scope of the invention is to be determined entirely by the followingclaims.

The invention may be practiced in ways other than those particularlydescribed in the foregoing description and examples. Numerousmodifications and variations of the invention are possible in light ofthe above teachings and, therefore, are within the scope of the appendedclaims.

Certain teachings related to methods for obtaining a clonal populationof antigen-specific B cells were disclosed in U.S. Patent ApplicationPublication No. 2007/0269868.

Certain teachings related to humanization of rabbit-derived monoclonalantibodies and preferred sequence modifications to maintain antigenbinding affinity were disclosed in U.S. Patent Application PublicationNo. 2009/0104187.

Certain teachings related to producing antibodies or fragments thereofusing mating competent yeast and corresponding methods were disclosed inU.S. Patent Application Publication No. 2006/0270045.

Certain teachings related to anti-IL-6 antibodies, methods of producingantibodies or fragments thereof using mating competent yeast andcorresponding methods were disclosed in U.S. Patent ApplicationPublication No. 2009/0104187.

Certain teachings related to anti-IL-6 antibodies and methods of usingthose antibodies or fragments thereof to address certain diseases and/ordisorders were disclosed in U.S. Patent Application Publication No.2010/0150829.

Certain anti-IL-6 antibody polynucleotides and polypeptides aredisclosed in the sequence listing accompanying this patent applicationfiling, and the disclosure of said sequence listing is hereinincorporated by reference in its entirety.

The following examples are put forth so as to provide those of ordinaryskill in the art with a complete disclosure and description of how tomake and use the subject invention, and are not intended to limit thescope of what is regarded as the invention. Efforts have been made toensure accuracy with respect to the numbers used (e.g., amounts,temperature, concentrations) but some experimental errors and deviationsshould be allowed for. Unless otherwise indicated, parts are parts byweight, molecular weight is average molecular weight, temperature is indegrees centigrade; and pressure is at or near atmospheric.

EXAMPLES

In the following examples, the term “Ab1” refers to an antibodycomprising the light chain sequence of SEQ ID NO: 702 and the heavychain sequence of SEQ ID NO: 704, except where the context indicatesotherwise. The laboratory designation “Ab1” also encompasses ananti-IL-6 antibody also known as “ALD518” and “BMS-945429” comprisingthe light chain sequence of SEQ ID NO: 19 and the heavy chain sequenceof SEQ ID NO: 20.

Example 1 Production of Enriched Antigen-Specific B Cell AntibodyCulture

Panels of antibodies are derived by immunizing traditional antibody hostanimals to exploit the native immune response to a target antigen ofinterest. Typically, the host used for immunization is a rabbit or otherhost that produces antibodies using a similar maturation process andprovides for a population of antigen-specific B cells producingantibodies of comparable diversity, e.g., epitopic diversity. Theinitial antigen immunization can be conducted using complete Freund'sadjuvant (CFA), and the subsequent boosts effected with incompleteadjuvant. At about 50-60 days after immunization, preferably at day 55,antibody titers are tested, and the Antibody Selection (ABS) process isinitiated if appropriate titers are established. The two key criteriafor ABS initiation are potent antigen recognition and function-modifyingactivity in the polyclonal sera.

At the time positive antibody titers are established, animals aresacrificed and B cell sources isolated. These sources include: thespleen, lymph nodes, bone marrow, and peripheral blood mononuclear cells(PBMCs). Single cell suspensions are generated, and the cell suspensionsare washed to make them compatible for low temperature long termstorage. The cells are then typically frozen.

To initiate the antibody identification process, a small fraction of thefrozen cell suspensions are thawed, washed, and placed in tissue culturemedia. These suspensions are then mixed with a biotinylated form of theantigen that was used to generate the animal immune response, andantigen-specific cells are recovered using the Miltenyi magnetic beadcell selection methodology. Specific enrichment is conducted usingstreptavidin beads. The enriched population is recovered and progressedin the next phase of specific B cell isolation.

Example 2 Production of Clonal, Antigen-Specific B Cell-ContainingCulture

Enriched B cells produced according to Example 1 are then plated atvarying cell densities per well in a 96 well microtiter plate.Generally, this is at 50, 100, 250, or 500 cells per well with 10 platesper group. The media is supplemented with 4% activated rabbit T cellconditioned media along with 50K frozen irradiated EL4B feeder cells.These cultures are left undisturbed for 5-7 days at which timesupernatant-containing secreted antibody is collected and evaluated fortarget properties in a separate assay setting. The remaining supernatantis left intact, and the plate is frozen at −70° C. Under theseconditions, the culture process typically results in wells containing amixed cell population that comprises a clonal population ofantigen-specific B cells, i.e., a single well will only contain a singlemonoclonal antibody specific to the desired antigen.

Example 3 Screening of Antibody Supernatants for Monoclonal Antibody ofDesired Specificity and/or Functional Properties

Antibody-containing supernatants derived from the well containing aclonal antigen-specific B cell population produced according to Example2 are initially screened for antigen recognition using ELISA methods.This includes selective antigen immobilization (e.g., biotinylatedantigen capture by streptavidin coated plate), non-specific antigenplate coating, or alternatively, through an antigen build-up strategy(e.g., selective antigen capture followed by binding partner addition togenerate a heteromeric protein-antigen complex). Antigen-positive wellsupernatants are then optionally tested in a function-modifying assaythat is strictly dependant on the ligand. One such example is an invitro protein-protein interaction assay that recreates the naturalinteraction of the antigen ligand with recombinant receptor protein.Alternatively, a cell-based response that is ligand dependent and easilymonitored (e.g., proliferation response) is utilized. Supernatant thatdisplays significant antigen recognition and potency is deemed apositive well. Cells derived from the original positive well are thentransitioned to the antibody recovery phase.

Example 4 Recovery of Single, Antibody-Producing B Cell of DesiredAntigen Specificity

Cells are isolated from a well that contains a clonal population ofantigen-specific B cells (produced according to Example 2 or 3), whichsecrete a single antibody sequence. The isolated cells are then assayedto isolate a single, antibody-secreting cell. Dynal® (magnetic beads)streptavidin beads are coated with biotinylated target antigen underbuffered medium to prepare antigen-containing microbeads compatible withcell viability. Next antigen-loaded beads, antibody-producing cells fromthe positive well, and a fluorescein isothiocyanate (FITC)-labeledanti-host H&L IgG antibody (as noted, the host can be any mammalianhost, e.g., rabbit, mouse, rat) are incubated together at 37° C. Thismixture is then re-pipetted in aliquots onto a glass slide such thateach aliquot has on average a single, antibody-producing B-cell. Theantigen-specific, antibody-secreting cells are then detected throughfluorescence microscopy. Secreted antibody is locally concentrated ontothe adjacent beads due to the bound antigen and provides localizationinformation based on the strong fluorescent signal. Antibody-secretingcells are identified via FITC detection of antibody-antigen complexesformed adjacent to the secreting cell. The single cell found in thecenter of this complex is then recovered using a micromanipulator. Thecell is snap-frozen in an eppendorf PCR tube for storage at −80° C.until antibody sequence recovery is initiated.

Example 5 Isolation of Antibody Sequences from Antigen-Specific B Cell

Antibody sequences are recovered using a combined RT-PCR based methodfrom a single isolated B-cell produced according to Example 4 or anantigenic specific B cell isolated from the clonal B cell populationobtained according to Example 2. Primers are designed to anneal inconserved and constant regions of the target immunoglobulin genes (heavyand light), such as rabbit immunoglobulin sequences, and a two-stepnested PCR recovery step is used to obtain the antibody sequence.Amplicons from each well are analyzed for recovery and size integrity.The resulting fragments are then digested with AluI to fingerprint thesequence clonality. Identical sequences display a common fragmentationpattern in their electrophoretic analysis. Significantly, this commonfragmentation pattern which proves cell clonality is generally observedeven in the wells originally plated up to 1000 cells/well. The originalheavy and light chain amplicon fragments are then restriction enzymedigested with HindIII and XhoI or HindIII and BsiWI to prepare therespective pieces of DNA for cloning. The resulting digestions are thenligated into an expression vector and transformed into bacteria forplasmid propagation and production. Colonies are selected for sequencecharacterization.

Example 6 Recombinant Production of Monoclonal Antibody of DesiredAntigen Specificity and/or Functional Properties

Correct full-length antibody sequences for each well containing a singlemonoclonal antibody is established and miniprep DNA is prepared usingQiagen solid-phase methodology. This DNA is then used to transfectmammalian cells to produce recombinant full-length antibody. Crudeantibody product is tested for antigen recognition and functionalproperties to confirm the original characteristics are found in therecombinant antibody protein. Where appropriate, large-scale transientmammalian transfections are completed, and antibody is purified throughProtein A affinity chromatography. Kd is assessed using standard methods(e.g., Biacore®) as well as IC50 in a potency assay.

Example 7 Preparation of Antibodies that Bind Human IL-6

By using the antibody selection protocol described herein, one cangenerate an extensive panel of antibodies. The antibodies have highaffinity towards IL-6 (single to double digit pM Kd) and demonstratepotent antagonism of IL-6 in multiple cell-based screening systems(T1165 and HepG2). Furthermore, the collection of antibodies displaysdistinct modes of antagonism toward IL-6-driven processes.

Immunization Strategy

Rabbits were immunized with huIL-6 (R&R). Immunization consisted of afirst subcutaneous (sc) injection of 100 μg in complete Freund'sadjuvant (CFA) (Sigma) followed by two boosts, two weeks apart, of 50 μgeach in incomplete Freund's adjuvant (IFA) (Sigma). Animals were bled onday 55, and serum titers were determined by ELISA (antigen recognition)and by non-radioactive proliferation assay (Promega) using the T1165cell line.

Antibody Selection Titer Assessment

Antigen recognition was determined by coating Immulon 4 plates (Thermo)with 1 μg/mL of huIL-6 (50 μL/well) in phosphate buffered saline (PBS,Hyclone) overnight at 4° C. On the day of the assay, plates were washed3 times with PBS/Tween 20 (PBST tablets, Calbiochem). Plates were thenblocked with 200 μL/well of 0.5% fish skin gelatin (FSG, Sigma) in PBSfor 30 minutes at 37° C. Blocking solution was removed, and plates wereblotted. Serum samples were made (bleeds and pre-bleeds) at a startingdilution of 1:100 (all dilutions were made in FSG 50 μL/well) followedby 1:10 dilutions across the plate (column 12 was left blank forbackground control). Plates were incubated for 30 minutes at 37° C.Plates were washed 3 times with PBS/Tween 20. Goat anti-rabbit Fc-HRP(Pierce) diluted 1:5000 was added to all wells (50 μL/well), and plateswere incubated for 30 minutes at 37° C. Plates were washed as describedabove. 50 μL/well of TMB-Stable stop (Fitzgerald Industries) was addedto plates, and color was allowed to develop, generally for 3 to 5minutes. The development reaction was stopped with 50 μL/well 0.5 M HCl.Plates were read at 450 nm. Optical density (OD) versus dilution wasplotted using Graph Pad Prizm software, and titers were determined.

Functional Titer Assessment

The functional activity of the samples was determined by a T1165proliferation assay. T1165 cells were routinely maintained in modifiedRPMI medium (Hyclone) supplemented with HEPES, sodium pyruvate, sodiumbicarbonate, L-glutamine, high glucose, penicillin/streptomycin, 10%heat inactivated fetal bovine serum (FBS) (all supplements fromHyclone), 2-mercaptoethanol (Sigma), and 10 ng/mL of huIL-6 (R&D). Onthe day of the assay, cell viability was determined by trypan blue(Invitrogen), and cells were seeded at a fixed density of 20,000cells/well. Prior to seeding, cells were washed twice in the mediumdescribed above without human-IL-6 (by centrifuging at 13000 rpm for 5minutes and discarding the supernatant). After the last wash, cells wereresuspended in the same medium used for washing in a volume equivalentto 50 μL/well. Cells were set aside at room temperature.

In a round-bottom, 96-well plate (Costar), serum samples were addedstarting at 1:100, followed by a 1:10 dilution across the plate (columns2 to 10) at 30 μL/well in replicates of 5 (rows B to F: dilution made inthe medium described above with no huIL-6). Column 11 was medium onlyfor IL-6 control. 30 μL/well of huIL-6 at 4× concentration of the finalEC50 (concentration previously determined) were added to all wells(huIL-6 was diluted in the medium described above). Wells were incubatedfor 1 hour at 37° C. to allow antibody binding to occur. After 1 hour,50 μL/well of antibody-antigen (Ab—Ag) complex were transferred to aflat-bottom, 96-well plate (Costar) following the plate map format laidout in the round-bottom plate. On Row G, 50 μL/well of medium were addedto all wells (columns 2 to 11) for background control. 50 μL/well of thecell suspension set aside were added to all wells (columns 2 to 11, rowsB to G). On Columns 1 and 12 and on rows A and H, 200 μL/well of mediumwas added to prevent evaporation of test wells and to minimize edgeeffect. Plates were incubated for 72 hours at 37° C. in 4% CO₂. At 72hours, 20 μL/well of CellTiter96 (Promega) reagents was added to alltest wells per manufacturer protocol, and plates were incubated for 2hours at 37° C. At 2 hours, plates were gently mixed on an orbitalshaker to disperse cells and to allow homogeneity in the test wells.Plates were read at 490 nm wavelength. Optical density (OD) versusdilution was plotted using Graph Pad Prizm software, and functionaltiter was determined. A positive assay control plate was conducted asdescribed above using MAB2061 (R&D Systems) at a starting concentrationof 1 μg/mL (final concentration) followed by 1:3 dilutions across theplate.

Tissue Harvesting

Once acceptable titers were established, the rabbit(s) were sacrificed.Spleen, lymph nodes, and whole blood were harvested and processed asfollows:

Spleen and lymph nodes were processed into a single cell suspension bydisassociating the tissue and pushing through sterile wire mesh at 70 μm(Fisher) with a plunger of a 20 cc syringe. Cells were collected in themodified RPMI medium described above without huIL-6, but with lowglucose. Cells were washed twice by centrifugation. After the last wash,cell density was determined by trypan blue. Cells were centrifuged at1500 rpm for 10 minutes; the supernatant was discarded. Cells wereresuspended in the appropriate volume of 10% dimethyl sulfoxide (DMSO,Sigma) in FBS (Hyclone) and dispensed at 1 mL/vial. Vials were thenstored at −70° C. for 24 h prior to being placed in a liquid nitrogen(LN2) tank for long-term storage.

Peripheral blood mononuclear cells (PBMCs) were isolated by mixing wholeblood with equal parts of the low glucose medium described above withoutFBS. 35 mL of the whole blood mixture was carefully layered onto 8 mL ofLympholyte Rabbit (Cedarlane) into a 45 mL conical tube (Corning) andcentrifuged 30 minutes at 2500 rpm at room temperature without brakes.After centrifugation, the PBMC layers were carefully removed using aglass Pasteur pipette (VWR), combined, and placed into a clean 50 mLvial. Cells were washed twice with the modified medium described aboveby centrifugation at 1500 rpm for 10 minutes at room temperature, andcell density was determined by trypan blue staining. After the lastwash, cells were resuspended in an appropriate volume of 10% DMSO/FBSmedium and frozen as described herein.

B Cell Culture

On the day of setting up B cell culture, PBMC, splenocyte, or lymph nodevials were thawed for use. Vials were removed from LN2 tank and placedin a 37° C. water bath until thawed. Contents of vials were transferredinto 15 mL conical centrifuge tube (Corning) and 10 mL of modified RPMIdescribed above was slowly added to the tube. Cells were centrifuged for5 minutes at 1.5K RPM, and the supernatant was discarded. Cells wereresuspended in 10 mL of fresh media. Cell density and viability wasdetermined by trypan blue. Cells were washed again and resuspended at1E07 cells/80 μL medium. Biotinylated huIL-6 (B huIL-6) was added to thecell suspension at the final concentration of 3 μg/mL and incubated for30 minutes at 4° C. Unbound B huIL-6 was removed with two 10 mL washesof phosphate-buffered (PBF):Ca/Mg free PBS (Hyclone), 2 mMethylenediamine tetraacetic acid (EDTA), 0.5% bovine serum albumin (BSA)(Sigma-biotin free). After the second wash, cells were resuspended at1E07 cells/80 μL PBF. 20 μL of MACS® streptavidin beads (Milteni)/10E7cells were added to the cell suspension. Cells were incubated at 4° C.for 15 minutes. Cells were washed once with 2 mL of PBF/10E7 cells.After washing, the cells were resuspended at 1E08 cells/500 μL of PBFand set aside. A MACS® MS column (Milteni) was pre-rinsed with 500 mL ofPBF on a magnetic stand (Milteni). Cell suspension was applied to thecolumn through a pre-filter, and unbound fraction was collected. Thecolumn was washed with 1.5 mL of PBF buffer. The column was removed fromthe magnet stand and placed onto a clean, sterile 5 mL PolypropyleneFalcon tube. 1 mL of PBF buffer was added to the top of the column, andpositive selected cells were collected. The yield and viability ofpositive and negative cell fraction was determined by trypan bluestaining. Positive selection yielded an average of 1% of the startingcell concentration.

A pilot cell screen was established to provide information on seedinglevels for the culture. Three 10-plate groups (a total of 30 plates)were seeded at 50, 100, and 200 enriched B cells/well. In addition, eachwell contained 50K cells/well of irradiated EL-4.B5 cells (5,000 Rads)and an appropriate level of T cell supernatant (ranging from 1-5%depending on preparation) in high glucose modified RPMI medium at afinal volume of 250 μL/well. Cultures were incubated for 5 to 7 days at37° C. in 4% CO₂.

Identification of Selective Antibody Secreting B Cells

Cultures were tested for antigen recognition and functional activitybetween days 5 and 7.

Antigen Recognition Screening

The ELISA format used is as described above except 50 μL of supernatantfrom the B cell cultures (BCC) wells (all 30 plates) was used as thesource of the antibody. The conditioned medium was transferred toantigen-coated plates. After positive wells were identified, thesupernatant was removed and transferred to a 96-well master plate(s).The original culture plates were then frozen by removing all thesupernatant except 40 μL/well and adding 60 μL/well of 16% DMSO in FBS.Plates were wrapped in paper towels to slow freezing and placed at −70°C.

Functional Activity Screening

Master plates were then screened for functional activity in the T1165proliferation assay as described before, except row B was media only forbackground control, row C was media+IL-6 for positive proliferationcontrol, and rows D-G and columns 2-11 were the wells from the BCC (50μL/well, single points). 40 μL of IL-6 was added to all wells except themedia row at 2.5 times the EC50 concentration determined for the assay.After 1 hour incubation, the Ab/Ag complex was transferred to a tissueculture (TC) treated, 96-well, flat-bottom plate. 20 μL of cellsuspension in modified RPMI medium without huIL-6 (T1165 at 20,000cells/well) was added to all wells (100 μL final volume per well).Background was subtracted, and observed OD values were transformed into% of inhibition.

B Cell Recovery

Plates containing wells of interest were removed from −70° C., and thecells from each well were recovered with 5-200 μL washes of medium/well.The washes were pooled in a 1.5 mL sterile centrifuge tube, and cellswere pelleted for 2 minutes at 1500 rpm.

The tube was inverted, the spin repeated, and the supernatant carefullyremoved. Cells were resuspended in 100 μL/tube of medium. 100 μLbiotinylated IL-6 coated streptavidin M280 dynabeads (Invitrogen) and 16μL of goat anti-rabbit H&L IgG-FITC diluted 1:100 in medium was added tothe cell suspension.

20 μL of cell/beads/FITC suspension was removed, and 5 μL droplets wereprepared on a glass slide (Corning) previously treated with Sigmacote(Sigma), 35 to 40 droplets/slide. An impermeable barrier of paraffin oil(JT Baker) was added to submerge the droplets, and the slide wasincubated for 90 minutes at 37° C., 4% CO₂ in the dark.

Specific B cells that produce antibody can be identified by thefluorescent ring around them due to antibody secretion, recognition ofthe bead-associated biotinylated antigen, and subsequent detection bythe fluorescent-IgG detection reagent. Once a cell of interest wasidentified, the cell in the center of the fluorescent ring was recoveredvia a micromanipulator (Eppendorf). The single cell synthesizing andexporting the antibody was transferred into a 250 μL microcentrifugetube and placed in dry ice. After recovering all cells of interest,these were transferred to −70° C. for long-term storage.

Example 8 Yeast Cell Expression

Antibody Genes:

Genes were cloned and constructed that directed the synthesis of achimeric humanized rabbit monoclonal antibody.

Expression Vector:

The vector contains the following functional components: 1) a mutantColE1 origin of replication, which facilitates the replication of theplasmid vector in cells of the bacterium Escherichia coli; 2) abacterial Sh ble gene, which confers resistance to the antibioticZeocin® (phleomycin) and serves as the selectable marker fortransformations of both E. coli and P. pastoris; 3) an expressioncassette composed of the glyceraldehyde dehydrogenase gene (GAP gene)promoter, fused to sequences encoding the Saccharomyces cerevisiae alphamating factor pre pro secretion leader sequence, followed by sequencesencoding a P. pastoris transcriptional termination signal from the P.pastoris alcohol oxidase I gene (AOX1). The Zeocin® (phleomycin)resistance marker gene provides a means of enrichment for strains thatcontain multiple integrated copies of an expression vector in a strainby selecting for transformants that are resistant to higher levels ofZeocin® (phleomycin).

Pichia pastoris Strains:

Pichia pastoris strains met1, lys3, ura3 and ade1 may be used. Althoughany two complementing sets of auxotrophic strains could be used for theconstruction and maintenance of diploid strains, these two strains areespecially suited for this method for two reasons. First, they grow moreslowly than diploid strains that are the result of their mating orfusion. Thus, if a small number of haploid ade1 or ura3 cells remainpresent in a culture or arise through meiosis or other mechanism, thediploid strain should outgrow them in culture.

The second is that it is easy to monitor the sexual state of thesestrains since diploid Ade+ colonies arising from their mating are anormal white or cream color, whereas cells of any strains that arehaploid ade1 mutants will form a colony with a distinct pink color. Inaddition, any strains that are haploid ura3 mutants are resistant to thedrug 5-fluoro-orotic acid (FOA) and can be sensitively identified byplating samples of a culture on minimal medium+uracil plates with FOA.On these plates, only uracil-requiring ura3 mutant (presumably haploid)strains can grow and form colonies. Thus, with haploid parent strainsmarked with ade1 and ura3, one can readily monitor the sexual state ofthe resulting antibody-producing diploid strains (haploid versusdiploid).

Methods

Construction of pGAPZ-alpha expression vectors for transcription oflight and heavy chain antibody genes. The humanized light and heavychain fragments were cloned into the pGAPZ expression vectors through aPCR directed process. The recovered humanized constructs were subjectedto amplification under standard KOD polymerase (Novagen) kit conditions((1) 94° C., 2 minutes; (2) 94° C., 30 seconds (3) 55° C., 30 seconds;(4) 72° C., 30 seconds-cycling through steps 2-4 for 35 times; (5) 72°C. 2 minutes) employing the following primers (1) light chain forwardAGCGCTTATTCCGCTATCCAGATGACCCAGTC—the AfeI site is single underlined (SEQID NO: 729). The end of the HSA signal sequence is double underlined,followed by the sequence for the mature variable light chain (notunderlined); the reverse CGTACGTTTGATTTCCACCTTG (SEQ ID NO: 730).

Variable light chain reverse primer. BsiWI site is underlined, followedby the reverse complement for the 3′ end of the variable light chain.Upon restriction enzyme digest with AfeI and BsiWI this enable insertionin-frame with the pGAPZ vector using the human HAS leader sequence inframe with the human kapp light chain constant region for export. (2) Asimilar strategy is performed for the heavy chain. The forward primeremployed is AGCGCT TATTCCGAGGTGCAGCTGGTGGAGTC (SEQ ID NO: 731). The AfeIsite is single underlined. The end of the HSA signal sequence is doubleunderlined, followed by the sequence for the mature variable heavy chain(not underlined). The reverse heavy chain primer is CTCGAGACGGTGACGAGGGT(SEQ ID NO: 732). The XhoI site is underlined, followed by the reversecomplement for the 3′ end of the variable heavy chain. This enablescloning of the heavy chain in-frame with IgG-γ1 CH1-CH2-CH3 regionprevious inserted within pGAPZ using a comparable directional cloningstrategy.

Transformation of Expression Vectors into Haploid Ade1 Ura3, Met1 andLys3 Host Strains of P. pastoris.

All methods used for transformation of haploid P. pastoris strains andgenetic manipulation of the P. pastoris sexual cycle are as described inHiggins, D. R., and Cregg, J. M., Eds. 1998. Pichia Protocols. Methodsin Molecular Biology. Humana Press, Totowa, N.J.

Prior to transformation, each expression vector is linearized within theGAP promoter sequences with AvrII to direct the integration of thevectors into the GAP promoter locus of the P. pastoris genome. Samplesof each vector are then individually transformed into electrocompetentcultures of the ade1, ura3, met1 and lys3 strains by electroporation andsuccessful transformants are selected on YPD Zeocin® (phleomycin) platesby their resistance to this antibiotic. Resulting colonies are selected,streaked for single colonies on YPD Zeocin® (phleomycin) plates and thenexamined for the presence of the antibody gene insert by a PCR assay ongenomic DNA extracted from each strain for the proper antibody geneinsert and/or by the ability of each strain to synthesize an antibodychain by a colony lift/immunoblot method. Wung, et al. (1996)Biotechniques 21: 808-812. Haploid ade1, met1 and lys3 strainsexpressing one of the three heavy chain constructs are collected fordiploid constructions along with haploid ura3 strain expressing lightchain gene. The haploid expressing heavy chain genes are mated with theappropriate light chain haploid ura3 to generate diploid secretingprotein.

Mating of haploid strains synthesizing a single antibody chain andselection of diploid derivatives synthesizing tetrameric functionalantibodies. To mate P. pastoris haploid strains, each ade1 (or met1 orlys3) heavy chain producing strain to be crossed is streaked across arich YPD plate and the ura3 light chain producing strain is streakedacross a second YPD plate (˜10 streaks per plate). After one or two daysincubation at 30° C., cells from one plate containing heavy chainstrains and one plate containing ura3 light chain strains aretransferred to a sterile velvet cloth on a replica-plating block in across hatched pattern so that each heavy chain strain contain a patch ofcells mixed with each light chain strain. The cross-streaked replicaplated cells are then transferred to a mating plate and incubated at 25°C. to stimulate the initiation of mating between strains. After twodays, the cells on the mating plates are transferred again to a sterilevelvet on a replica-plating block and then transferred to minimal mediumplates. These plates are incubated at 30° C. for three days to allow forthe selective growth of colonies of prototrophic diploid strains.Colonies that arose are picked and streaked onto a second minimal mediumplate to single colony isolate and purify each diploid strain. Theresulting diploid cell lines are then examined for antibody production.

Putative diploid strains are tested to demonstrate that they are diploidand contain both expression vectors for antibody production. Fordiploidy, samples of a strain are spread on mating plates to stimulatethem to go through meiosis and form spores. Haploid spore products arecollected and tested for phenotype. If a significant percentage of theresulting spore products are single or double auxotrophs it may beconcluded that the original strain must have been diploid. Diploidstrains are examined for the presence of both antibody genes byextracting genomic DNA from each and utilizing this DNA in PCR reactionsspecific for each gene.

Fusion of haploid strains synthesizing a single antibody chain andselection of diploid derivatives synthesizing tetrameric functionalantibodies. As an alternative to the mating procedure described above,individual cultures of single-chain antibody producing haploid ade1 andura3 strains are spheroplasted and their resulting spheroplasts fusedusing polyethylene glycol/CaCl₂. The fused haploid strains are thenembedded in agar containing 1 M sorbitol and minimal medium to allowdiploid strains to regenerate their cell wall and grow into visiblecolonies. Resulting colonies are picked from the agar, streaked onto aminimal medium plate, and the plates are incubated for two days at 30°C. to generate colonies from single cells of diploid cell lines. Theresulting putative diploid cell lines are then examined for diploidy andantibody production as described above.

Purification and analysis of antibodies. A diploid strain for theproduction of full length antibody is derived through the mating of met1light chain and lys3 heavy chain using the methods described above.Culture media from shake-flask or fermenter cultures of diploid P.pastoris expression strains are collected and examined for the presenceof antibody protein via SDS-PAGE and immunoblotting using antibodiesdirected against heavy and light chains of human IgG, or specificallyagainst the heavy chain of IgG.

To purify the yeast secreted antibodies, clarified media from antibodyproducing cultures are passed through a protein A column and afterwashing with 20 mM sodium phosphate, pH 7.0, binding buffer, protein Abound protein is eluted using 0.1 M glycine HCl buffer, pH 3.0.Fractions containing the most total protein are examined by Coomasieblue strained SDS-PAGE and immunoblotting for antibody protein. Antibodyis characterized using the ELISA described above for IL-6 recognition.

Assay for Antibody Activity.

The recombinant yeast-derived humanized antibody is evaluated forfunctional activity through the IL-6 driven T1165 cell proliferationassay and IL-6 stimulated HepG2 haptoglobin assay described above.

Example 9 Acute Phase Response Neutralization by IntravenousAdministration of Anti-IL-6 Antibody Ab1

Human IL-6 can provoke an acute phase response in rats, and one of themajor acute phase proteins that is stimulated in the rat is alpha-2macroglobulin (A2M). A study was designed to assess the dose of antibodyAb1 required to ablate the A2M response to a single subcutaneousinjection of 100 μg of human IL-6 given one hour after different doses(0.03, 0.1, 0.3, 1, and 3 mg/kg) of antibody Ab1 administeredintravenously (n=10 rats/dose level) or polyclonal human IgG1 as thecontrol (n=10 rats). Plasma was recovered and the A2M was quantitatedvia a commercial sandwich ELISA kit (ICL Inc., Newberg Oreg.; cat.no.-E-25A2M). The endpoint was the difference in the plasmaconcentration of A2M at the 24 hour time point (post-Ab1).

The ID50 for antibody Ab1 was 0.1 mg/kg with complete suppression of theA2M response at the 0.3 mg/kg. See FIG. 6. This demonstrates that theIL-6 may be neutralized in vivo by anti-IL-6 antibodies describedherein.

Example 10 RXF393 Cachexia Model Study 1

Introduction

The human renal cell cancer cell line, RXF393 produces profound weightloss when transplanted into athymic nude mice. Weight loss begins aroundday 15 after transplantation with 80% of all animals losing at least 30%of their total body weight by day 18-20 after transplantation. RXF393secretes human IL-6 and the plasma concentration of human IL-6 in theseanimals is very high at around 10 ng/ml. Human IL-6 can bind murinesoluble IL-6 receptor and activate IL-6 responses in the mouse. HumanIL-6 is approximately 10 times less potent than murine IL-6 atactivating IL-6 responses in the mouse. The objectives of this studywere to determine the effect of antibody Ab1, on survival, body weight,serum amyloid A protein, hematology parameters, and tumor growth inathymic nude mice transplanted with the human renal cell cancer cellline, RXF393.

Methods

Eighty, 6 week old, male athymic nude mice were implanted with RXF393tumor fragments (30-40 mg) subcutaneously in the right flank. Animalswere then divided into eight groups of ten mice. Three groups were giveneither antibody Ab1 at 3 mg/kg, 10 mg/kg, or 30 mg/kg intravenouslyweekly on day 1, day 8, day 15 and day 22 after transplantation(progression groups). Another three groups were given either antibodyAb1 at 3 mg/kg, or 10 mg/kg, or 30 mg/kg intravenously weekly on day 8,day 15 and day 22 after transplantation (regression groups). Finally,one control group was given polyclonal human IgG 30 mg/kg and a secondcontrol group was given phosphate buffered saline intravenously weeklyon day 1, day 8, day 15 and day 22 after transplantation.

Animals were euthanized at either day 28, when the tumor reached 4,000mm³ or if they became debilitated (>30% loss of body weight). Animalswere weighed on days 1, 6 and then daily from days 9 to 28 aftertransplantation. Mean Percent Body Weight (MPBW) was used as the primaryparameter to monitor weight loss during the study. It was calculated asfollows: (Body Weight−Tumor Weight)/Baseline Body Weight×100. Tumorweight was measured on days 1, 6, 9, 12, 15, 18, 22, 25 and 28 aftertransplantation. Blood was taken under anesthesia from five mice in eachgroup on days 5 and 13 and all ten mice in each group when euthanized(day 28 in most cases). Blood was analyzed for hematology and serumamyloid A protein (SAA) concentration. An additional group of 10non-tumor bearing 6 week old, athymic nude male mice had blood samplestaken for hematology and SAA concentration estimation to act as abaseline set of values.

Results—Survival

No animals were euthanized or died in any of the antibody Ab1 groupsprior to the study termination date of day 28. In the two controlgroups, 15 animals (7/9 in the polyclonal human IgG group and 8/10 inthe phosphate buffered saline group) were found dead or were euthanizedbecause they were very debilitated (>30% loss of body weight). Mediansurvival time in both control groups was 20 days.

The survival curves for the two control groups and the antibody Ab1progression (dosed from day 1 of the study) groups are presented in FIG.7.

The survival curves for the two control groups and the antibody Ab1regression (dosed from day 8 of the study) groups are presented in FIG.8.

There was a statistically significant difference between the survivalcurves for the polyclonal human IgG (p=0.0038) and phosphate bufferedsaline (p=0.0003) control groups and the survival curve for the sixantibody Ab1 groups. There was no statistically significant differencebetween the two control groups (p=0.97).

Results—Tumor Size

Tumor size in surviving mice was estimated by palpation. For the first15 days of the study, none of the mice in any group were found dead orwere euthanized, and so comparison of tumor sizes between groups onthese days was free from sampling bias. No difference in tumor size wasobserved between the antibody Ab1 progression or regression groups andthe control groups through day 15. Comparison of the tumor size betweensurviving mice in the control and treatment groups subsequent to theonset of mortality in the controls (on day 15) was not undertakenbecause tumor size the surviving control mice was presumed to be biasedand accordingly the results of such comparison would not be meaningful.

As administration of antibody Ab1 promoted survival without any apparentreduction in tumor size, elevated serum IL-6 may contribute to mortalitythrough mechanisms independent of tumor growth. These observationssupports the hypothesis that antibody Ab1 can promote cancer patientsurvivability without directly affecting tumor growth, possibly byenhancing general patient well-being.

Results—Weight Loss

Compared to controls, mice dosed with Ab1 were protected from weightloss. On day 18, MPBW in control mice was 75%, corresponding to anaverage weight loss of 25%. In contrast, on the same day, MPBW in Ab-1treatment groups was minimally changed (between 97% and 103%). There wasa statistically significant difference between the MPBW curves for thecontrols (receiving polyclonal human IgG or PBS) and the 10 mg/kg dosagegroup (p<0.0001) or 3 mg/kg and 30 mg/kg dosage groups (p<0.0005). Therewas no statistically significant difference between the two controlgroups.

Control mice are emaciated compared to the normal appearance of theAb1-treated mouse. These results suggest that Ab1 may be useful toprevent or treat cachexia caused by elevated IL-6 in humans.

Results—Plasma Serum Amyloid A

The mean (±SEM) plasma serum amyloid A concentration versus time for thetwo control groups and the antibody Ab1 progression (dosed from day 1 ofthe study) and regression (dosed from day 8 of the study) groups arepresented in Table 6.

TABLE 6 Mean Plasma SAA - antibody Ab1, all groups versus control groupsMean Plasma Mean Plasma Mean Plasma SAA ± SEM Day 5 SAA ± SEM Day 13 SAA± SEM Terminal (μg/ml) (μg/ml) Bleed (μg/ml) Polyclonal IgG 30 mg/kg 675 ± 240 (n = 5) 3198 ± 628 (n = 4) 13371 ± 2413 (n = 4) iv weeklyfrom day 1 PBS iv weekly from day 1  355 ± 207 (n = 5) 4844 ± 1126 (n =5) 15826 ± 802 (n = 3) Ab1 30 mg/kg iv weekly  246 ± 100 (n = 5) 2979 ±170 (n = 5)  841 ± 469 (n = 10) from day 1 Ab1 10 mg/kg iv weekly 3629 ±624 (n = 5) 3096 ± 690 (n = 5)  996 ± 348 (n = 10) from day 1 Ab1 3mg/kg iv weekly  106 ± 9 (n = 5) 1623 ± 595 (n = 4)  435 ± 70 (n = 9)from day 1 Ab1 30 mg/kg iv weekly  375 ± 177 (n = 5) 1492 ± 418 (n = 4) 498 ± 83 (n = 9) from day 8 Ab1 10 mg/kg iv weekly  487 ± 170 (n = 5)1403 ± 187 (n = 5)  396 ± 58 (n = 10) from day 8 Ab1 3 mg/kg iv weekly1255 ± 516 (n = 5)  466 ± 157 (n = 5)  685 ± 350 (n = 5) from day 8

SAA is up-regulated via the stimulation of hIL-6 and this response isdirectly correlated with circulating levels of hIL-6 derived from theimplanted tumor. The surrogate marker provides an indirect readout foractive hIL-6. Thus in the two treatment groups described above there aresignificantly decreased levels of SAA due to the neutralization oftumor-derived hIL-6. This further supports the contention that antibodyAb1 displays in vivo efficacy.

Example 11 RXF393 Cachexia Model Study 2

Introduction

A second study was performed in the RXF-393 cachexia model wheretreatment with antibody Ab1 was started at a later stage (days 10 and 13post-transplantation) and with a more prolonged treatment phase (out to49 days post transplantation). The dosing interval with antibody Ab1 wasshortened to 3 days from 7 and also daily food consumption was measured.There was also an attempt to standardize the tumor sizes at the time ofinitiating dosing with antibody Ab1.

Methods

Eighty, 6 week old, male athymic nude mice were implanted with RXF393tumor fragments (30-40 mg) subcutaneously in the right flank. 20 micewere selected whose tumors had reached between 270-320 mg in size anddivided into two groups. One group received antibody Ab1 at 10 mg/kgi.v. every three days and the other group received polyclonal humanIgG10 mg/kg every 3 days from that time-point (day 10 aftertransplantation). Another 20 mice were selected when their tumor sizehad reached 400-527 mg in size and divided into two groups. One groupreceived antibody Ab1 at 10 mg/kg i.v. every three days and the othergroup received polyclonal human IgG10 mg/kg every 3 days from thattime-point (day 13 after transplantation). The remaining 40 mice took nofurther part in the study and were euthanized at either day 49, when thetumor reached 4,000 mm³ or if they became very debilitated (>30% loss ofbody weight).

Animals were weighed every 3-4 days from day 1 to day 49 aftertransplantation. Mean Percent Body Weight (MPBW) was used as the primaryparameter to monitor weight loss during the study. It was calculated asfollows: ((Body Weight−Tumor Weight)/Baseline Body Weight)×100. Tumorweight was measured every 3-4 days from day 5 to day 49 aftertransplantation. Food consumption was measured (amount consumed in 24hours by weight (g) by each treatment group) every day from day 10 forthe 270-320 mg tumor groups and day 13 for the 400-527 mg tumor groups.

Results—Survival

The survival curves for antibody Ab1 at 10 mg/kg i.v. every three days(270-320 mg tumor size) and for the polyclonal human IgG10 mg/kg i.v.every three days (270-320 mg tumor size) are presented in FIG. 9.

Median survival for the antibody Ab1 at 10 mg/kg i.v. every three days(270-320 mg tumor size) was 46 days and for the polyclonal human IgG at10 mg/kg i.v. every three days (270-320 mg tumor size) was 32.5 days(p=0.0071).

The survival curves for the antibody Ab1 at 10 mg/kg i.v. every threedays (400-527 mg tumor size) and for the polyclonal human IgG at 10mg/kg i.v. every three days (400-527 mg tumor size) are presented inFIG. 10. Median survival for the antibody Ab1 at 10 mg/kg i.v. everythree days (400-527 mg tumor size) was 46.5 days and for the polyclonalhuman IgG at 10 mg/kg i.v. every three days (400-527 mg tumor size) was27 days (p=0.0481).

Example 12 Multi-Dose Pharmacokinetic Evaluation of Antibody Ab1 inNon-Human Primates

Antibody Ab1 was dosed in a single bolus infusion to a single male andsingle female cynomologus monkey in phosphate buffered saline. Plasmasamples were removed at fixed time intervals and the level of antibodyAb1 was quantitated through of the use of an antigen capture ELISAassay. Biotinylated IL-6 (50 μl of 3 μg/mL) was captured on Streptavidincoated 96 well microtiter plates. The plates were washed and blockedwith 0.5% Fish skin gelatin. Appropriately diluted plasma samples wereadded and incubated for 1 hour at room temperature. The supernatantsremoved and an anti-hFc-HRP conjugated secondary antibody applied andleft at room temperature.

The plates were then aspirated and TMB added to visualize the amount ofantibody. The specific levels were then determined through the use of astandard curve. A second dose of antibody Ab1 was administered at day 35to the same two cynomologus monkeys and the experiment replicated usingan identical sampling plan.

This humanized full length aglycosylated antibody expressed and purifiedPichia pastoris displays comparable characteristics to mammalianexpressed protein. In addition, multiple doses of this product displayreproducible half-lives inferring that this production platform does notgenerate products that display enhanced immunogenicity.

Example 13 Octet Mechanistic Characterization of Antibody Proteins

IL-6 signaling is dependent upon interactions between IL-6 and tworeceptors, IL-6R1 (CD126) and gp 130 (IL-6 signal transducer). Todetermine the antibody mechanism of action, mechanistic studies wereperformed using bio-layer interferometry with an Octet QK instrument(ForteBio; Menlo Park, Calif.). Studies were performed in two differentconfigurations. In the first orientation, biotinylated IL-6 (R&D systemspart number 206-IL-001MG/CF, biotinylated using Pierce EZ-linksulfo-NHS-LC-LC-biotin product number 21338 according to manufacturer'sprotocols) was initially bound to a streptavidin coated biosensor(ForteBio part number 18-5006). Binding is monitored as an increase insignal.

The IL-6 bound to the sensor was then incubated either with the antibodyin question or diluent solution alone. The sensor was then incubatedwith soluble IL-6R1 (R&D systems product number 227-SR-025/CF) molecule.If the IL-6R1 molecule failed to bind, the antibody was deemed to blockIL-6/IL-6R1 interactions. These complexes were incubated with gp130 (R&Dsystems 228-GP-010/CF) in the presence of IL-6R1 for stability purposes.If gp130 did not bind, it was concluded that the antibody blocked gp130interactions with IL-6.

In the second orientation, the antibody was bound to a biosensor coatedwith an anti-human IgG1 Fc-specific reagent (ForteBio part number18-5001). The IL-6 was bound to the immobilized antibody and the sensorwas incubated with IL-6R1. If the IL-6R1 did not interact with the IL-6,then it was concluded that the IL-6 binding antibody blocked IL-6/IL-6R1interactions. In those situations where antibody/IL-6/IL-6R1 wasobserved, the complex was incubated with gp 130 in the presence ofIL-6R1. If gp 130 did not interact, then it was concluded that theantibody blocked IL-6/gp130 interactions. All studies were performed ina 200 μL final volume, at 30° C. and 1000 rpm. For these studies, allproteins were diluted using ForteBio's sample diluent buffer (partnumber 18-5028). Results are presented in TABLE 7.

TABLE 7 Anti-IL6 Antibodies binding to R1 or GP130 Blocks IL6 Blocks IL6Antibody binding to R1 Binding to GP130 Ab1 Yes Yes Ab2 No Partial Ab3No Yes Ab4 No Yes Ab6 Yes Yes Ab7 Yes Yes Ab8 No Yes

Example 14 Peptide Mapping

In order to determine the epitope recognized by Ab1 on human IL-6, theantibody was employed in a western-blot based assay. The form of humanIL-6 utilized in this example had a sequence of 183 amino acids inlength. A 57-member library of overlapping 15 amino acid peptidesencompassing this sequence was commercially synthesized and covalentlybound to a PepSpots nitrocellulose membrane (JPT Peptide technologies,Berlin, Germany). The sequences of the overlapping 15 amino acidpeptides is in SEQ ID NOs: 590-646. Blots were prepared and probedaccording to the manufacturer's recommendations.

Briefly, blots were pre-wet in methanol, rinsed in PBS, and blocked forover 2 hours in 10% non-fat milk in PBS/0.05% Tween (Blocking Solution).The Ab1 antibody was used at 1 mg/mL final dilution, and theHRP-conjugated Mouse Anti-Human-Kappa secondary antibody (SouthernBioTech #9220-05) was used at a 1:5000 dilution. Antibodydilutions/incubations were performed in blocking solution. Blots weredeveloped using Amersham ECL advance reagents (GE# RPN2135) andchemiluminescent signal documented using a CCD camera (AlphaInnotec).The sequence of the form of human IL-6 utilized to generate peptidelibrary is set forth in SEQ ID NO: 1.

Example 15 Ab1 has High Affinity for IL-6

Surface plasmon resonance was used to measure association rate (Ka),dissociation rate (Kd) and dissociation constant (KD) for Ab1 to IL-6from rat, mouse, dog, human, and cynomolgus monkey at 25° C. (TABLE 5).The dissociation constant for human IL-6 was 4 pM, indicating very highaffinity. As expected, affinity generally decreased with phylogeneticdistance from human. The dissociation constants of Ab1 for IL-6 ofcynomolgus monkey, rat, and mouse were 31 pM, 1.4 nM, and 0.4 nM,respectively. Ab1 affinity for dog IL-6 below the limit of quantitationof the experiment.

The high affinity of Ab1 for mouse, rat, and cynomolgus monkey IL-6suggest that Ab1 may be used to inhibit IL-6 of these species. Thishypothesis was tested using a cell proliferation assay. In brief, eachspecies's IL-6 was used to stimulate proliferation of T1165 cells, andthe concentration at which Ab1 could inhibit 50% of proliferation (IC50)was measured. Inhibition was consistent with the measured dissociationconstants (TABLE 6). These results demonstrate that Ab1 can inhibit thenative IL-6 of these species, and suggest the use of these organisms forin vitro or in vivo modeling of IL-6 inhibition by Ab1. Further, otherIL-6 antibodies described herein may have similar properties.

TABLE 8 Surface Plasmon Resonance: Averaged binding constants determinedat 25° C. for Ab1 to IL-6. Species (IL-6) K_(a) (M⁻¹s⁻¹) K_(d) (s⁻¹)K_(D) Rat 1.6e⁶ 2.2e⁻³ 1.4 nM Mouse 1.1e⁶ 4.0e⁻⁴ 0.4 nM Dog BelowLOQ^(a) Below LOQ^(a) Below LOQ^(a) Human 1.6e⁵   5e⁻⁷   4 pM Cynomolgus9.6e⁴   3e⁻⁶  31 pM monkey ^(a)Below Limit of Quantitation

TABLE 9 IC50 values for Ab1 against human, cynomolgus monkey, mouse, ratand dog IL-6 in the T1165 assay. IL-6 Species IC50 (pM) Human 13Cynomolgus monkey 12 Mouse 1840 Rat 2060 Dog No inhibition of cellproliferation

Example 16 Multi-Dose Pharmacokinetic Evaluation of Antibody Ab1 inHealthy Human Volunteers

Antibody Ab1 was dosed in a single bolus infusion in histidine andsorbitol to healthy human volunteers. Dosages of 1 mg, 3 mg, 10 mg, 30mg or 100 mg were administered to each individual in dosage groupscontaining five to six individuals. Plasma samples were removed at fixedtime intervals for up to twelve weeks. Human plasma was collected viavenipuncture into a vacuum collection tube containing EDTA. Plasma wasseparated and used to assess the circulating levels of Ab1 using amonoclonal antibody specific for Ab1, as follows. A 96 well microtiterplate was coated overnight with the monoclonal antibody specific for Ab1in 1×PBS overnight at 4° C. The remaining steps were conducted at roomtemperature. The wells were aspirated and subsequently blocked using0.5% Fish Skin Gelatin (FSG) (Sigma) in 1×PBS for 60 minutes. Humanplasma samples were then added and incubated for 60 minutes, thenaspirated, then 50 μL of 1 μg/mL biotinylated IL-6 was then added toeach well and incubated for 60 minutes. The wells were aspirated, and 50μL streptavidin-HRP (Pharmingen), diluted 1:5,000 in 0.5% FSG/PBS, wasadded and incubated for 45 minutes. Development was conducted usingstandard methods employing TMB for detection. Levels were thendetermined via comparison to a standard curve prepared in a comparableformat.

Average plasma concentration of Ab1 for each dosage group was examined.Mean AUC and Cmax increased linearly with dosage. For dosages of 30 mgand above, the average Ab1 half-life in each dosage group was betweenapproximately 25 and 30 days. The pharmocokinetics is shown in Table 10.

TABLE 10 Summary of Ab1 Pharmacokinetics in Health Human VolunteersT_(1/2) AUC C_(max) Dose of Ab1 (days) (μg · h/mL) (μg/mL) T_(max)  1 mg10.3 35 0.1 8  3 mg 11.6 229 0.7 4  10 mg 22.4 1473 4.0 4  30 mg 25.19076 19.7 4 100 mg 30.3 26128 48.0 12 300 mg 26.2 92891 188.0 12 640 mg30.2 175684 306.0 12

Example 17 Pharmacokinetics of Ab1 in Patients with Advanced Cancer

Antibody Ab1 was dosed in a single bolus infusion in phosphate bufferedsaline to five individuals with advanced cancer. Each individualreceived a dosage of 80 mg (n=2) or 160 mg (n=3) of Ab1. Plasma sampleswere drawn weekly, and the level of antibody Ab1 was quantitated as inExample 16. Average plasma concentration of Ab1 in these individuals asa function of time was examined. The average Ab1 half-life wasapproximately 31 days. The anti-IL-6 antibodies described herein mayhave similarly long half-lives.

Example 18 Ab1 has an Unexpectedly Long Half-Life

Overall, the average half-life of Ab1 was approximately 31 days inhumans (for dosages of 10 mg and above), and approximately 15-21 days incynomolgus monkey. The Ab1 half-life in humans and cynomolgus monkeysare unprecedented when compared with the half-lives of other anti-IL-6antibodies (TABLE 11). As described above, Ab1 was derived fromhumanization of a rabbit antibody, and is produced from Pichia pastorisin an aglycosylated form. These characteristics results in an antibodywith very low immunogenicity in humans. Moreover, the lack ofglycosylation prevents Ab1 from interacting with the Fc receptor orcomplement. Without intent to be limited by theory, it is believed thatthe unexpectedly long half-life of Ab1 is at least partiallyattributable to the humanization and/or the lack of glycosylation. Theparticular sequence and/or structure of the antigen binding surfaces mayalso contribute to Ab1's half-life. See also WO 2011/066369.

TABLE 11 Elimination Half-life of Ab1 Cynomolgus Monkey Human Dose ofAB1 (days) (days) Ab1 15-21 ~31 Acemra (Tocilizumab) 7 6 Remicade 5  8-9.5 Synagis 8.6 20 Erbitux 3-7 5 Zenapax 7 20 Avastin 10 20Pertuzumab 10 18-22

Example 19 Ab1 Effect on Hemoglobin Concentration, Plasma LipidConcentration, and Neutrophil Counts in Patients with Advanced Cancer

Antibody Ab1 was dosed in a single bolus infusion in phosphate bufferedsaline to eight individuals with advanced cancer (NSCLC, colorectalcancer, cholangiocarcinoma, or mesothelioma). Each individual received adosage of 80 mg, 160 mg, or 320 mg of Ab1. Blood samples were removedjust prior to infusion and at fixed time intervals for six weeks, andthe hemoglobin concentration, plasma lipid concentration, and neutrophilcounts were determined. Average hemoglobin concentration rose slightly(FIG. 11), as did total cholesterol and triglycerides (FIG. 12), whilemean neutrophil counts fell slightly (FIG. 13).

These results further demonstrate some of the beneficial effects ofadministration of Ab1 to chronically ill individuals. Because IL-6 isthe main cytokine responsible for the anemia of chronic disease(including cancer-related anemia), neutralization of IL-6 by Ab1increases hemoglobin concentration in these individuals. Similarly, asIL-6 is centrally important in increasing neutrophil counts ininflammation, the observed slight reduction in neutrophil counts furtherconfirms that Ab1 inhibits IL-6. Finally, IL-6 causes anorexia as wellas cachexia in these patients; neutralization of IL-6 by Ab1 results inthe return of appetite and reversal of cachexia. The increase in plasmalipid concentrations reflects the improved nutritional status of thepatients. Taken together, these results further demonstrate that Ab1effectively reverses these adverse consequences of IL-6 in thesepatients.

Example 20 Ab1 Suppresses Serum CRP in Healthy Volunteers and inPatients with Advanced Cancer

Introduction

Serum CRP concentrations have been identified as a strong prognosticindicator in patients with certain forms of cancer. For example,Hashimoto et al. performed univariate and multivariate analysis ofpreoperative serum CRP concentrations in patients with hepatocellularcarcinoma in order to identify factors affecting survival and diseaserecurrence. Hashimoto, et al. (2005) Cancer 103(9): 1856-1864. Patientswere classified into two groups, those with serum CRP levels >1.0 mg/dL(“the CRP positive group”) and those with serum CRP levels <1.0 mg/dL(“the CRP negative group”). The authors identified “a significantcorrelation between preoperative serum CRP level and tumor size.” Id.Furthermore, the authors found that “[t]he overall survival andrecurrence-free survival rates in the CRP-positive group weresignificantly lower compared with the rates in the CRP-negative group.”Id. The authors concluded that the preoperative CRP level of patients isan independent and significant predictive indicator or poor prognosisand early recurrence in patients with hepatocellular carcinoma.

Similar correlations have been identified by other investigators. Forexample, Karakiewicz et al. determined that serum CRP was an independentand informative predictor of renal cell carcinoma-specific mortality.Karakiewicz, et al. (2007) Cancer. 110(6):1241-1247. Accordingly, thereremains a need in the art for methods and/or treatments that reduceserum C-Reactive Protein (CRP) concentrations in cancer patients, andparticularly those with advanced cancers.

Methods

Healthy volunteers received a single 1-hour intravenous (IV) infusion ofeither 100 mg (5 patients), 30 mg (5 patients), 10 mg (6 patients), 3 mg(6 patients) or 1 mg (6 patients) of the Ab1 monoclonal antibody, whileanother 14 healthy volunteers received intravenous placebo.Comparatively, 2 patients with advanced forms of colorectal cancerreceived a single 1-hour intravenous (IV) infusion of 80 mg of the Ab1monoclonal antibody. No further dosages of the Ab1 monoclonal antibodywere administered to the test population.

Patients were evaluated prior to administration of the dosage, andthereafter on a weekly basis for at least 5 weeks post dose. At the timeof each evaluation, patients were screened for serum CRP concentration.

Results—Healthy Volunteers

As noted above, serum CRP levels are a marker of inflammation;accordingly, baseline CRP levels are typically low in healthyindividuals. The low baseline CRP levels can make a further reduction inCRP levels difficult to detect. Nonetheless, a substantial reduction inserum CRP concentrations was detectable in healthy volunteers receivingall concentrations of the Ab1 monoclonal antibody, compared to controls(FIG. 14A). The reduction in serum CRP levels was rapid, occurringwithin one week of antibody administration, and prolonged, continuing atleast through the final measurement was taken (8 or 12 weeks fromantibody administration).

Results—Cancer Patients

Five advanced cancer patients (colorectal cancer, cholangiocarcinoma, orNSCLC) having elevated serum CRP levels were dosed with 80 mg or 160 mgof Ab1. Serum CRP levels were greatly reduced in these patients (FIG.14B). The reduction in serum CRP levels was rapid, with 90% of thedecrease occurring within one week of Ab1 administration, and prolonged,continuing at least until the final measurement was taken (up to twelveweeks). In two representative individuals, the CRP levels were loweredto below the normal reference range (less than 5-6 mg/l) within oneweek. Thus, administration of Ab1 to patients can cause a rapid andsustained suppression of serum CRP levels.

Example 21 Ab1 Improved Muscular Strength, Improved Weight, and ReducedFatigue in Patients with Advanced Cancer

Introduction

Weight loss and fatigue (and accompanying muscular weakness) are verycommon symptoms of patients with advanced forms of cancer, and thesesymptoms can worsen as the cancer continues to progress. Fatigue, weightloss and muscular weakness can have significant negative effects on therecovery of patients with advanced forms of cancer, for example bydisrupting lifestyles and relationships and affecting the willingness orability of patients to continue cancer treatments. Known methods ofaddressing fatigue, weight loss and muscular weakness include regularroutines of fitness and exercise, methods of conserving the patient'senergy, and treatments that address anemia-induced fatigue and muscularweakness. Nevertheless, there remains a need in the art for methodsand/or treatments that improve fatigue, weight loss and muscularweakness in cancer patients.

Methods

Four patients with advanced forms of cancer [(colorectal cancer (2),NSCLC (1), cholangiocarcinoma (1)] received a single 1-hour intravenous(IV) infusion of either 80 mg or 160 mg of the Ab1 monoclonal antibody.No further dosages of the Ab1 monoclonal antibody were administered tothe test population.

Patients were evaluated prior to administration of the dosage, andthereafter for at least 6 weeks post dose. At the time of eachevaluation, patients were screened for the following: a.) any change inweight; b.) fatigue as measured using the Facit-F Fatigue Subscalequestionnaire a medically recognized test for evaluating fatigue. See,e.g., Cella, et al. (2002) Cancer 94(2): 528-538; Cella, et al. (2002)Journal of Pain & Symptom Management 24(6): 547-561); and hand-gripstrength (a medically recognized test for evaluating muscle strength,typically employing a handgrip dynamometer).

Results—Weight Change

The averaged data for both dosage concentrations (80 mg and 160 mg) ofthe Ab1 monoclonal antibody demonstrated an increase of about 2kilograms of weight per patient over the period of 6 weeks.

Fatigue

The averaged data for both dosage concentrations (80 mg and 160 mg) ofthe Ab1 monoclonal antibody demonstrated an increase in the mean Facit-FFS subscale score of at least about 10 points in the patient populationover the period of 6 weeks.

Hand-Grip Strength

The averaged data for both dosage concentrations (80 mg and 160 mg) ofthe Ab1 monoclonal antibody demonstrated an increase in the meanhand-grip strength of at least about 10 percent in the patientpopulation over the period of 6 weeks. See, e.g., WO 2011/066371.

Example 22 Ab1 for Prevention of Thrombosis

Prior studies have shown that administration of an anti-IL-6 antibodycan cause decreased platelet counts. Emilie, et al. (1994) Blood 84(8):2472-9; Blay, et al. (1997) Int J Cancer 72(3): 424-30. These resultshave apparently been viewed as an indicator of potential danger, becausefurther decreases in platelet counts could cause complications such asbleeding. However, Applicants have now discerned that inhibiting IL-6restores a normal coagulation profile, which Applicants predict willprevent thrombosis. Decreased platelet counts resulting from inhibitionof IL-6 is not a sign of potential danger but rather reflects thebeneficial restoration of normal coagulation.

The mechanism by which normal coagulation is restored is believed toresult from the interplay between IL-6 and the acute phase reaction. Inresponse to elevated IL-6 levels, as for example in a cancer patient,the liver produces acute phase proteins. These acute phase proteinsinclude coagulation factors, such as Factor II, Factor V, Factor VIII,Factor IX, Factor XI, Factor XII, F/fibrin degradation products,thrombin-antithrombin III complex, fibrinogen, plasminogen, prothrombin,and von Willebrand factor. This increase in coagulation factors may bemeasured directly, or may be inferred from functional measurements ofclotting ability. Antagonists of IL-6, such as Ab1, suppresses acutephase proteins, e.g., Serum Amyloid (Example 10). Applicants now predictthat this suppression of acute phase proteins will restore the normalcoagulation profile, and thereby prevent thrombosis. The restoration ofnormal coagulation may cause a slight drop in platelet counts, but thepatient will nonetheless retain normal coagulation ability and thus willnot have an increased risk of bleeding. Such a treatment will representa vast improvement over the available anticoagulation therapies whoseusefulness is limited by the risk of adverse side-effects, such as majorbleeding. See, e.g., WO 2011/066371.

Applicants contemplate that the same beneficial effects of inhibitingIL-6 will be obtained regardless of the method of inhibition. Suitablemethods of inhibiting IL-6 include administration of anti-IL-6antibodies, antisense therapy, soluble IL-6 receptor, eitherindividually or in combinations.

Example 23 Ab1 Increases Plasma Albumin Concentration in Patients withAdvanced Cancer

Introduction

Serum albumin concentrations are recognized as predictive indicators ofsurvival and/or recovery success of cancer patients. Hypoalbumeniacorrelates strongly with poor patient performance in numerous forms ofcancer. For example, in one study no patients undergoing systemicchemotherapy for metastatic pancreatic adenocarcinoma and having serumalbumin levels less than 3.5 g/dL successfully responded to systemicchemotherapy. Fujishiro, et al. (2000) Hepatogastroenterology 47(36):1744-46 and Senior and Maroni (1999) Am. Soc. Nutr. Sci. 129: 313S-314S.In at least one study, attempts to rectify hypoalbuminemia in 27patients with metastatic cancer by daily intravenous albumin infusion of20 g until normal serum albumin levels (>3.5 g/dL) were achieved hadlittle success. Demirkazik, et al. (2002) Proc. Am. Soc. Clin. Oncol.21:Abstr 2892. Accordingly, there remains a need in the art for methodsand/or treatments that improve serum albumin concentrations in cancerpatients and address hypoalbuminemic states in cancer patients,particularly those with advanced cancers.

Methods

Four patients with advanced forms of cancer [(colorectal cancer (2),NSCLC (1), cholangiocarcinoma (1)] received a single 1-hour intravenous(IV) infusion of either 80 mg or 160 mg of the Ab1 monoclonal antibody.No further dosages of the Ab1 monoclonal antibody were administered tothe test population.

Patients were evaluated prior to administration of the dosage, andthereafter for at least 6 weeks post dose. At the time of eachevaluation, patients were screened for plasma albumin concentration.

Results

The averaged data for both dosage concentrations (80 mg and 160 mg) ofthe Ab1 monoclonal antibody demonstrated an increase of about 5 g/L ofplasma albumin concentration per patient over the period of 6 weeks.See, e.g., WO 2011/066371.

Example 24 Ab1 Suppresses Serum CRP in Patients with Advanced Cancer

Introduction

Serum CRP concentrations have been identified as a strong prognosticindicator in patients with certain forms of cancer. For example,Hashimoto et al. performed univariate and multivariate analysis ofpreoperative serum CRP concentrations in patients with hepatocellularcarcinoma in order to identify factors affecting survival and diseaserecurrence. Hashimoto, et al. (2005) Cancer 103(9): 1856-1864. Patientswere classified into two groups, those with serum CRP levels >1.0 mg/dL(“the CRP positive group”) and those with serum CRP levels <1.0 mg/dL(“the CRP negative group”). The authors identified “a significantcorrelation between preoperative serum CRP level and tumor size.” Id.Furthermore, the authors found that “[t]he overall survival andrecurrence-free survival rates in the CRP-positive group weresignificantly lower compared with the rates in the CRP-negative group.”Id. The authors concluded that the preoperative CRP level of patients isan independent and significant predictive indicator of poor prognosisand early recurrence in patients with hepatocellular carcinoma.

Similar correlations have been identified by other investigators. Forexample, Karakiewicz et al. determined that serum CRP was an independentand informative predictor of renal cell carcinoma-specific mortality.Karakiewicz, et al. (2007) Cancer 110(6):1241-1247. Accordingly, thereremains a need in the art for methods and/or treatments that reduceserum C-Reactive Protein (CRP) concentrations in cancer patients, andparticularly those with advanced cancers.

Methods

One-hundred twenty-four patients with non-small cell lung cancer (NSCLC)were divided into 4 treatment groups. Patients in one group received one1-hour intravenous (IV) infusion of either placebo (n=31), 80 mg (n=29),160 mg (n=32), or 320 mg (n=32) of the Ab1 monoclonal antibody every 8weeks over a 24 week duration for a total of 3 doses. CRP concentrationwas quantitated by a C-reactive protein particle-enhancedimmunoturbidimetric assay using latex-attached anti-CRP antibodies (i.e.Roche CRP Tinaquant®). Briefly, about 1.0 mL of patient sample serum wascollected and stored in a plastic collection tube. Sample was placedinto appropriate buffer, and anti-CRP antibody coupled to latexmicroparticles was added to the sample to start the reaction. Theseanti-CRP antibodies with conjugated latex microparticles react withantigen in the sample to form an antigen/antibody complex. Followingagglutination, this was measured turbidimetrically using a Roche/HitachiModular P analizer.

Patients were evaluated prior to administration of the dosage, andthereafter at weeks 2, 4, 8, and 12. At the time of each evaluation,patients were screened for serum CRP concentration.

Results

The averaged data for each dosage concentrations (placebo, 80 mg, 160mg, and 320 mg) of the Ab1 monoclonal antibody are plotted in FIG. 15A.All dosage levels of Ab1 antibody demonstrated an immediate drop in CRPconcentrations relative to placebo over the period of 12 weeks. CRPlevels displayed breakthrough at 8 weeks post-dosing. The CRP levelsfell below 5 mg/L by week 12. Median values of CRP demonstrated rapidand sustained decreases for all dosage concentrations relative toplacebo (FIG. 15B). Thus, administration of Ab1 to advanced cancerpatients can cause a rapid and sustained suppression of serum CRPlevels.

Example 25 Ab1 Suppresses Serum CRP in Patients with Advanced Cancers

Introduction

Serum CRP concentrations have been identified as a strong prognosticindicator in patients with certain forms of cancer. For example,Hashimoto et al. performed univariate and multivariate analysis ofpreoperative serum CRP concentrations in patients with hepatocellularcarcinoma in order to identify factors affecting survival and diseaserecurrence. Hashimoto, et al. (2005) Cancer 103(9): 1856-1864. Patientswere classified into two groups, those with serum CRP levels >1.0 mg/dL(“the CRP positive group”) and those with serum CRP levels <1.0 mg/dL(“the CRP negative group”). The authors identified “a significantcorrelation between preoperative serum CRP level and tumor size.” Id.Furthermore, the authors found that “[t]he overall survival andrecurrence-free survival rates in the CRP-positive group weresignificantly lower compared with the rates in the CRP-negative group.”Id. The authors concluded that the preoperative CRP level of patients isan independent and significant predictive indicator of poor prognosisand early recurrence in patients with hepatocellular carcinoma.

Similar correlations have been identified by other investigators. Forexample, Karakiewicz et al. determined that serum CRP was an independentand informative predictor of renal cell carcinoma-specific mortality.Karakiewicz, et al. (2007) Cancer 110(6): 1241-1247. Accordingly, thereremains a need in the art for methods and/or treatments that reduceserum C-Reactive Protein (CRP) concentrations in cancer patients, andparticularly those with advanced cancers.

Methods

Eight patients with various forms of advanced cancer [(colorectal (3),NSCLC (1), cholangio (1), and mesothelioma (2)] received a single 1-hourintravenous infusion of either 80 mg (2 patients), 160 mg (3 patients)or 320 mg (3 patients) of the Ab1 monoclonal antibody. No furtherdosages of the Ab1 monoclonal antibody were administered to the testpopulation.

Patients were evaluated prior to administration of the dosage andthereafter on a weekly basis for at least 8 weeks post dose. At the timeof each evaluation, patients were screened for serum CRP concentration.CRP concentration was quantitated by a C-reactive proteinparticle-enhanced immunoturbidimetric assay using latex-attachedanti-CRP antibodies (i.e. Roche CRP Tinaquant®). Briefly, about 1.0 mLof patient sample serum was collected and stored in a plastic collectiontube. Sample was placed into appropriate buffer, and anti-CRP antibodycoupled to latex microparticles was added to the sample to start thereaction. These anti-CRP antibodies with conjugated latex microparticlesreact with antigen in the sample to form an antigen/antibody complex.Following agglutination, this was measured turbidimetrically using aRoche/Hitachi Modular P analizer.

Results

Serum CRP levels were greatly reduced in all patients studied (FIG. 16).The reduction in serum CRP levels was rapid, with approximately 90% ofthe decrease occurring within one week of Ab1 administration, andprolonged diminished levels continued at least until the finalmeasurement was taken (up to twelve weeks). In all cases except onepatient with colorectal cancer, CRP levels fell to at or below thenormal reference range (less than 5-6 mg/L) within one week. Thecolorectal cancer patient achieved similar normal levels by week 4 ofthe study. Thus, administration of Ab1 to advanced cancer patients cancause a rapid and sustained suppression of serum CRP levels.

Example 26 Ab1 Suppresses Serum CRP in Patients with RheumatoidArthritis

Introduction

Serum CRP concentrations have been identified as a strong prognosticindicator in patients with rheumatoid arthritis. Patients suffering fromrheumatoid arthritis with high levels of CRP demonstrated almostuniversal deterioration. Amos, et al. (1977) Br. Med. J. 1: 195-97.Conversely, patients with low CRP levels showed no disease progression,suggesting that sustaining low levels of CRP is necessary foreffectively treating rheumatoid arthritis. Id. Tracking of CRP duringrheumatoid arthritis treatment regimes of gold, D-penicillamine,chloroquine, or dapsone indicated that radiological deterioration wasimpeded after the first 6 months of treatment when CRP levels wereconsistently controlled. Dawes et al., (1986) Rheumatology 25: 44-49. Ahighly significant correlation between CRP production and radiologicalprogression was identified. van Leeuwen, et al. (1997) Rheumatology 32(Supp. 3): 9-13. Another study revealed that for patients with activerheumatoid arthritis, suppression of abnormally elevated CRP led toimprovement in functional testing metrics, whereas sustained CRPelevation associated with deterioration in the same metrics. Devlin, etal. (1997) J. Rheumatol. 24: 9-13. No further deterioration was observedwithout CRP re-elevation, indicating CRP suppression as a viablecandidate for rheumatoid arthritis treatment. Id. Accordingly, thereremains a need in the art for methods and/or treatments that reduceserum C-Reactive Protein (CRP) concentrations in rheumatoid arthritispatients.

Methods

One-hundred twenty-seven patients with active rheumatoid arthritis andCRP ≧10 mg/L were divided into 4 treatment groups. Patients in one groupreceived one 1-hour intravenous (IV) infusion of either placebo (n=33),80 mg (n=32), 160 mg (n=34), or 320 mg (n=28) of the Ab1 monoclonalantibody, once at the start of the 16 week trial and again at week 8.CRP concentration was quantitated by a C-reactive proteinparticle-enhanced immunoturbidimetric assay using latex-attachedanti-CRP antibodies (i.e., Roche CRP Tinaquant®). Briefly, about 1.0 mLof patient sample serum was collected and stored in a plastic collectiontube. Sample was placed into appropriate buffer, and anti-CRP antibodycoupled to latex microparticles was added to the sample to start thereaction. These anti-CRP antibodies with conjugated latex microparticlesreact with antigen in the sample to form an antigen/antibody complex.Following agglutination, this was measured turbidimetrically using aRoche/Hitachi Modular P analizer. Data on CRP concentration wascollected every week for the first 4 weeks, every two weeks betweenweeks 4 and 12, and at the conclusion of the test at week 16.

Results

Serum CRP levels were greatly reduced in all patients studied (FIG. 17).The reduction in serum CRP levels was rapid, with immediate reduction inCRP levels relative to placebo within one week of Ab1 administration,and prolonged diminished levels continued at least until the finalmeasurement was taken (up to sixteen weeks). In all cases, CRP levelsfell to at or below the normal reference range (less than 5-6 mg/L)within one week. Thus, administration of Ab1 to rheumatoid arthritispatients can cause a rapid and sustained suppression of serum CRP levelsand presents an effective treatment regime.

Example 27 Ab1 Increases Hemoglobin in Patients with Advanced Cancer

Antibody Ab1 was dosed at 80 mg, 160 mg, or 320 mg of Ab1 in phosphatebuffered saline to 93 individuals with non-small cell lung carcinoma.The placebo group of 31 individuals with non-small cell lung carcinomawas dosed with phosphate buffered saline only. Blood samples wereremoved just prior to dosing (zero week), and at two, four, eight andtwelve weeks, and the hemoglobin concentration was determined. Meanhemoglobin concentration rose for those receiving antibody Ab1, whilemean hemoglobin concentration of those receiving placebo did not riseafter twelve weeks when compared to the concentration just prior todosing (zero week) (FIGS. 18A and 18B).

A subset of the study population began the study with low levels ofhemoglobin, defined as a baseline hemoglobin concentration below 11 g/l.Mean hemoglobin concentration rose above 11 g/l after eight weeks forthose receiving antibody Ab1 at dosages of 160 mg and 320 mg, while meanhemoglobin concentration of those receiving antibody Ab1 at dosages of80 mg or placebo did not rise above 11 g/l after eight weeks (FIG. 18C).

These results further demonstrate some of the beneficial effects ofadministration of Ab1 to chronically ill individuals. Because IL-6 isthe main cytokine responsible for the anemia of chronic disease(including cancer-related anemia), neutralization of IL-6 by Ab1increases hemoglobin concentration in these individuals.

Example 28 Ab1 Increases Hemoglobin in Patients with RheumatoidArthritis

Hemoglobin levels were analyzed in patients with rheumatoid arthritisduring treatment with Ab1 antibody. Ab1 antibody was dosed at 80 mg, 160mg, or 320 mg in phosphate buffered saline to 94 individuals withrheumatoid arthritis. The placebo group of 33 individuals withrheumatoid arthritis was dosed with phosphate buffered saline only.Blood samples were removed just prior to dosing (zero week), and at one,two, three, four, six, eight, ten, twelve, and sixteen weeks, and thehemoglobin concentration was determined. Mean hemoglobin concentrationrose for those receiving antibody Ab1, while mean hemoglobinconcentration of those receiving placebo did not appreciably rise aftersixteen weeks when compared to the concentration just prior to dosing(zero week) (FIG. 19).

These results further demonstrate some of the beneficial effects ofadministration of Ab1 to chronically ill individuals. Because IL-6 isthe main cytokine responsible for the anemia of chronic disease(including cancer-related anemia), neutralization of IL-6 by Ab1increases hemoglobin concentration.

Example 29 Ab1 Increases Albumin in Patients with Advanced Cancer

Introduction

Serum albumin concentrations are recognized as predictive indicators ofsurvival and/or recovery success of cancer patients. Hypoalbumeniacorrelates strongly with poor patient performance in numerous forms ofcancer. For example, in one study no patients undergoing systemicchemotherapy for metastatic pancreatic adenocarcinoma and having serumalbumin levels less than 3.5 g/dL successfully responded to systemicchemotherapy. Fujishiro, et al. (2000) Hepatogastroenterology 47(36):1744-46. The authors conclude that “[p]atients with . . .hypoalbuminemia . . . might be inappropriate candidates for systemicchemotherapy and might be treated with other experimental approaches orsupportive care.” Id.

Similarly, Senior and Maroni state that “[t]he recent appreciation thathypoalbuminemia is the most powerful predictor of mortality in end-stagerenal disease highlights the critical importance of ensuring adequateprotein intake in this patient population.” Senior & Maroni (1999) Am.Soc. Nutr. Sci. 129: 313S-314S.

In at least one study, attempts to rectify hypoalbuminemia in 27patients with metastatic cancer by daily intravenous albumin infusion of20 g until normal serum albumin levels (>3.5 g/dL) were achieved hadlittle success. The authors note that “[a]ibumin infusion for theadvanced stage cancer patients has limited value in clinical practice.Patients with PS 4 and hypoalbuminemia have poorer prognosis.”Demirkazik, et al. (2002) Proc. Am. Soc. Clin. Oncol. 21: Abstr 2892.

Accordingly, there remains a need in the art for methods and/ortreatments that improve serum albumin concentrations in cancer patientsand address hypoalbuminemic states in cancer patients, particularlythose with advanced cancers.

Methods

Antibody Ab1 was dosed at 80 mg, 160 mg, or 320 mg of Ab1 in phosphatebuffered saline to 93 individuals with non-small cell lung carcinoma.Each individual received a dosage of. The placebo group of 31individuals with non-small cell lung carcinoma was dosed with phosphatebuffered saline only. Blood samples were removed just prior to dosing(zero week), and at two, four, eight and twelve weeks, and the albuminconcentration was determined.

Results

Mean albumin concentration rose for those receiving antibody Ab1, whilemean albumin concentration of those receiving placebo did not rise aftertwelve weeks when compared to the concentration just prior to dosing(zero week) (FIG. 20A). The change from baseline albumin values for alldosage concentration groups is plotted in FIG. 20B.

A subset of the study population began the study with low levels ofalbumin, defined as a baseline albumin concentration less than or equalto 35 g/L. Mean albumin concentration initially rose with all dosages ofantibody Ab1 over placebo, but only patients receiving 160 mg or 320 mgdemonstrated sustained albumin levels above 35 g/L over 8 weeks of thestudy (FIG. 20C). The 80 mg dosage group demonstrated an initialincrease, but gradually declined after week 2 and never rose above 35g/L during the 8 weeks where data was available. Id.

Example 30 Ab1 Improved Weight and Reduced Fatigue in Patients withAdvanced Cancer

Introduction

Weight loss and fatigue are very common symptoms of patients withadvanced forms of cancer, and these symptoms can worsen as the cancercontinues to progress. Fatigue and weight loss can have significantnegative effects on the recovery of patients with advanced forms ofcancer, for example by disrupting lifestyles and relationships andaffecting the willingness or ability of patients to continue cancertreatments. Known methods of addressing fatigue and weight loss includeregular routines of fitness and exercise, methods of conserving thepatient's energy, and treatments that address anemia-induced fatigue.Nevertheless, there remains a need in the art for methods and/ortreatments that improve fatigue and weight loss in cancer patients.

Methods

One-hundred twenty-four patients with non-small cell lung cancer (NSCLC)were divided into 4 treatment groups. Patients in one group received one1-hour intravenous (IV) infusion of either placebo (n=31), 80 mg (n=29),160 mg (n=32), or 320 mg (n=32) of the Ab1 monoclonal antibody every 8weeks over a 24 week duration for a total of 3 doses.

Patients were evaluated prior to administration of the dosage, andthereafter for at least 12 weeks post dose. At the time of eachevaluation, patients were screened for the following: any change inweight; and fatigue as measured using the Facit-F Fatigue Subscalequestionnaire a medically recognized test for evaluating fatigue. See,e.g., Cella, et al. (2002) Cancer 94(2): 528-538; Cella, et al. (2002)Journal of Pain & Symptom Management 24(6): 547-561.

Results

Weight Change

The averaged weight change data from each dosage concentration group(placebo, 80 mg, 160 mg, and 320 mg) of the Ab1 monoclonal antibody over12 weeks. The average percent change in body weight from each dosageconcentration. The averaged lean body mass data for the dosageconcentration groups.

Fatigue

The averaged fatigue from each dosage concentration group (placebo, 80mg, 160 mg, and 320 mg) of the Ab1 monoclonal antibody demonstratedincreases in the mean Facit-F FS subscale score for some of the dosageconcentration groups in the patient population over the period of 8weeks.

Example 31 Ab1 Decreases D-Dimer Levels in Patients with Advanced Cancer

Introduction

D-dimer concentrations are recognized as useful diagnostic tools inpredicting risks of thrombotic events in patients. Adam, et al. (2009)Blood 113: 2878-87. Patients that are negative for D-dimer have a lowprobability for thrombosis. For example, D-dimer analysis can rule outsuspected lower-extremity deep-vein thrombosis in patients. Wells, etal. (2003) N. Engl. J. Med. 349: 1227-35. Clinical evaluation incombination with negative D-dimer test can effectively lower theinstance of pulmonary embolism to 0.5%. Van Belle, et al. (2006) JAMA295: 172-79; Kruip, et al. (2002) Arch. Intern. Med. 162: 1631-35;Wells, et al. (2001) Ann. Intern. Med. 135: 98-107.

D-dimer analysis may have utility in tracking the progress of treatingcoagulation disorders. One study indicated that anticoagulationtreatment for acute venous thromboembolism resulted in a gradual declinein D-dimer concentrations. Adam, et al. (2009) Blood 113: 2878-87;Schutgens, et al. (2004) J. Lab. Clin. Med. 144: 100-107. This discoveryled to the conclusion that D-dimer levels monitoring could be used toassess treatment responsiveness. Adam, at 2883.

For patients with cancer, D-dimer analysis may have additionalsignificance, as cancer increases the prevalence of thrombosis. Adam, etal. (2009) Blood 113: 2878-87. One study with oncology patientsindicated that D-dimer concentrations have a high negative predictivevalue and high sensitivity in diagnosing pulmonary embolism. King, etal. (2008) Radiology 247: 854-61. Deep-vein thrombosis can similarly beexcluded for cancer patients with low probability of developingdeep-vein thrombosis and a negative test for D-dimer, although such acombination is less likely for oncology patients. Lee, et al. (2008)Thromb. Res. 123: 177-83. A higher threshold for a negative D-dimerresult may be necessary in cancer patients. Righini, et al. (2006)Haemost. 95: 715-19.

Accordingly, there remains a need in the art for methods and/ortreatments of thrombosis that improve D-dimer concentrations in cancerpatients and address elevated D-dimer states in cancer patients,particularly those with advanced cancers.

Methods

One-hundred twenty-four patients with non-small cell lung cancer (NSCLC)were divided into 4 treatment groups. Patients in one group received one1-hour intravenous (IV) infusion of either placebo (n=31), 80 mg (n=29),160 mg (n=32), or 320 mg (n=32) of the Ab1 monoclonal antibody every 8weeks over a 24 week duration for a total of 3 doses. Data on D-dimerconcentration was collected for the first 8 weeks of treatment. D-dimerdata concentration was quantitated by a D-dimer immunoturbidimetricassay. Briefly, the assay is based on the change in turbidity of amicroparticle suspension that is measured by photometry. About 1.5 mL ofpatient sample sodium citrate plasma was collected and stored in aplastic collection tube. A suspension of latex microparticles, coated bycovalent bonding with monoclonal antibodies specific for D-dimer, wasmixed with the test plasma whose D-dimer level was to be assayed.Antigen-antibody reactions leading to an agglutination of the latexmicroparticles induced an increase in turbidity of the reaction medium.This increase in turbidity was reflected by an increase in absorbance,the latter being measured photometrically using a STAGO STA analyzer.The increase in absorbance was a function of the D-dimer level presentin the test sample.

Results

The averaged data for each dosage concentrations (placebo, 80 mg, 160mg, and 320 mg) of the Ab1 monoclonal antibody. All dosage levels of Ab1antibody demonstrated a drop in D-dimer levels over placebo over theperiod of 8 weeks. See WO 2011/066371.

Example 32 Ab1 Efficacy and Safety in Patients with Advanced NSCLC

The primary objective of this study was to determine the efficacy andsafety of ALD518 or humanized Ab1 in patients with advanced NSCLC.

Methods

124 patients (pts) with NSCLC, ECOG 0-3, weight loss in the preceding 3months of >5% body weight, hemoglobin (Hb) >7 g/dL, and C-reactiveprotein (CRP) >10 mg/L were dosed. Pts were randomized to 1 of 4 groups(n˜30/group). Placebo or ALD518 80 mg, 160 mg, or 320 mg wasadministered intravenously every 8 weeks. Pts were followed up for 24weeks. Data included hematology, clinical chemistry, CRP and adverseevents (AEs).

Results

29 pts completed the study treatments and evaluations, 38 failed tocomplete every visit, 52 died of progressive disease, and 5 withdrewbecause of adverse events. There were no dose limiting toxicities (DLTs)or infusion reactions. 84 pts had serious AEs of which 1 was deemed tobe possibly related to administration of ALD518 (rectal hemorrhage). Themean (±SD) values for Hb, hematocrit (Hct), mean corpuscular Hb (MCH),and albumin are below:

TABLE 12 Clinical Parameters measured for ALD518 (Ab1) versus Placebo nHb (g/dL) Hct (%) MCH (pg) Albumin (g/L) ALD518 Pre-dose 93 11.5 (±2.1)37.9 (±6.2) 28.4 (±2.8) 37.3 (±5.3) (pooled) Week 4 69 13.1 (±1.6)^(a)42.5 (±5.0)^(a) 29.2 (±2.5)^(a) 43.6 (±4.7)^(a) Week 12 39 13.4(±1.6)^(a) 42.5 (±4.7)^(b) 29.8 (±2.8)^(a) 45.2 (±4.5)^(a) PlaceboPre-dose 31 12.2 (±1.8) 39.0 (±5.9) 29.0 (±2.8) 37.5 (±5.7) Week 4 2911.8 (±2.0) 39.5 (±6.4) 28.0 (±2.8)^(c) 37.3 (±6.8) Week 12 21 12.0(±2.5) 39.6 (±7.4) 27.8 (±3.0)^(c) 37.0 (±7.5) ^(a)p < 0.0001 ^(b)p =0.0002 ^(c)p ≦ 0.001 (paired t-test compared to pre-dose)

38/93 pts treated ALD518 and 10/31 given placebo has a pre-dose Hb≦11g/dL. 24 of these pts on ALD518 and 7 of these pts on placebo remainedin the study at week 4. 14/24 pts on ALD518 and 0/7 on placebo hadraised their Hb from ≦11 g/dL to ≧12 g/dL.

Conclusion

ALD518 increased Hb, Hct, MCH and albumin in NSCLC pts and raised Hb to≧12 g/dL in 58% of pts with a Hb≦11 g/dL at baseline. This furtherindicates that ALD518 can be administered as a non-erythropoieticstimulating agent for treating cancer-related anemia.

Example 33 Ab1 Achieved ACR 20/50/70 in Patients with RheumatoidArthritis

Introduction

Rheumatoid arthritis is a chronic, systemic inflammatory disorder thatprincipally attack synovium of joints. The disease causes painful andpotentially disabling inflammation, with onset typically occurringbetween 40 and 50 years of age. Interpretation of drug treatmentefficacy in rheumatoid arthritis is made difficult by the myriad ofsubjective and objective assessment tools made available over the years.The American College of Rheumatology (“ACR”) released a standardized setof rheumatoid arthritis measures to facilitate evaluation of improvementof the disease in clinical trials. Felson, et al. (1993) Arthritis &Rheumatism 36: 729-40.

Methods

One-hundred twenty-seven patients with active rheumatoid arthritis andCRP ≧10 mg/L were divided into 4 treatment groups. Patients in one groupreceived one 1-hour intravenous (IV) infusion of either placebo (n=33),80 mg (n=32), 160 mg (n=34), or 320 mg (n=28) of the Ab1 monoclonalantibody, once at the start of the 16 week trial and again at week 8.Data on CRP concentration was collected every week for the first 4weeks, every two weeks between weeks 4 and 12, and at the conclusion ofthe test at week 16.

Assessment under the standardized protocols from the American College ofRheumatology were employed in determining the percentage of improvementof patients during the clinical trial and conducted by a person trainedin the ordinary art of evaluating rheumatoid arthritis. The evaluationwas based upon activity measures, including tender joint count, swollenjoint count, the patient's assessment of pain, the patient's andphysician's global assessments of disease activity, and laboratoryevaluation of either erythrocyte sedimentation rate or CRP level. Id.The patient's assessment of pain was based upon the Stanford HealthAssessment Questionnaire Disability Index (HAQ DI). Patients thatachieve a 20% increase in activity measures for rheumatoid arthritisduring a clinical trial are categorized as achieving ACR 20. Similarly,patients achieving 50% and 70% improvements are categorized as ACR 50and ACR 70, respectively.

Results

A significant portion of patients suffering from rheumatoid arthritisachieved ACR 20 or greater during the course of the study. See Table 13.Patients observed rapid improvement in systems within the first 4 weeksof the study, as well as continued, steady improvement throughout thecourse of the 16 week evaluation. The greatest results where exhibitedby patients receiving the 320 mg dosage level, with 43% achieving ACR 70status during the study.

TABLE 13 Percentage patients achieving ACR 20/50/70 at week 16 - MITTnon responder imputation Ab1 Ab1 Ab1 Ab1 Placebo 80 mg 160 mg 320 mgPooled (n = 33) (n = 32) (n = 34) (n = 28) (n = 94) ACR 36% 75% 65% 82%73% 20 (p = 0.0026) (p = 0.0283) (p = 0.0005) (p = 0.0002) ACR 15% 41%41% 50% 44% 50 (p = 0.0281) (p = 0.0291) (p = 0.0052) (p = 0.0032) ACR6% 22% 18% 43% 27% 70 (p = 0.0824) (p = 0.2585) (p = 0.0015) (p =0.0130)

Analysis of the individual components of the ACR evaluation demonstratedgains in every component. HAQ DI scores demonstrated clinicallymeaningful change over placebo during the course of the evaluation.Serum CRP levels were greatly reduced in all patients studied. Thereduction in serum CRP levels was rapid, with immediate reduction in CRPlevels relative to placebo within one week of Ab1 administration, andprolonged diminished levels continued at least until the finalmeasurement was taken (up to sixteen weeks). In all cases, CRP levelsfell to at or below the normal reference range (less than 5-6 mg/L)within one week. Thus, administration of Ab1 can cause a rapid andsustained improvement rheumatoid arthritis patients, as evidenced by thesignificant improvement in ACR scores during clinical evaluation, andpresents an effective treatment regime. See also WO 2011/066371.

Example 34 Ab1 Achieved Improved DAS28 and EULAR Scores in Patients withRheumatoid Arthritis

Introduction

Rheumatoid arthritis is a chronic, systemic inflammatory disorder thatprincipally attack synovium of joints. The disease causes painful andpotentially disabling inflammation, with onset typically occurringbetween 40 and 50 years of age. Interpretation of drug treatmentefficacy in rheumatoid arthritis is made difficult by the myriad ofsubjective and objective assessment tools made available over the years.The American College of Rheumatology (“ACR”) released a standardized setof rheumatoid arthritis measures to facilitate evaluation of improvementof the disease in clinical trials. Felson, et al. (1993) Arthritis &Rheumatism 36: 729-40.

Inflammatory activity associated with rheumatoid arthritis is measuredusing numerous variables through validated response criteria such asDisease Activity Score (DAS), DAS28 and EULAR. The DAS is a clinicalindex of rheumatoid arthritis disease activity that combines informationfrom swollen joints, tender joints, the acute phase response, andgeneral health. Fransen, et al. (2005) Clin. Exp. Rheumatol. 23(Suppl.39): S93-S99. The DAS 28 is an index similar to the original DAS, bututilizes a 28 tender joint count (range 0-28), a 28 swollen joint count(range 0-28), ESR (erythrocyte sedimentation rate), and an optionalgeneral health assessment on a visual analogue scale (range 0-100). Id.The European League against Rheumatism (EULAR) response criteriaclassify patients using the individual amount of change in the DAS andthe DAS value (low, moderate, high) reached into one of the followingclassifications: Good; Moderate; or Non-Responders. Id.

Methods

One-hundred twenty-seven patients with active rheumatoid arthritis weredivided into 4 treatment groups. Patients in one group received one1-hour intravenous (IV) infusion of either placebo (n=33), 80 mg (n=32),160 mg (n=34), or 320 mg (n=28) of the Ab1 monoclonal antibody, once atthe start of the 16 week trial and again at week 8. Data on the DAS28and EULAR scores was collected every week for the first 4 weeks, everytwo weeks between weeks 4 and 12, and at the conclusion of the test atweek 16. Assessment under the standardized DAS28 and EULAR protocolswere employed in determining the respective scores of patients duringthe clinical trial and conducted by a person trained in the ordinary artof evaluating rheumatoid arthritis.

Results

Patients receiving 80 mg, 160 mg or 320 mg of Ab1 demonstrated improvedDAS28 scores relative to those patients receiving placebo over thecourse of 16 weeks, as presented in FIG. 62 as a mean change from thebaseline DAS28 score. Furthermore, a significant percentage of patientsreceiving 80 mg, 160 mg or 320 mg of Ab1 achieved “Good” or “Moderate”classifications relative to those patients receiving placebo over thecourse of 16 weeks. Thus, administration of Ab1 can result in improvedDAS28 and EULAR scores in rheumatoid arthritis when compared to thosepatients receiving placebo. See WO 2011/066371.

Example 35 Safety, Pharmacokinetics (PK), and Pharmacodynamics (PD) ofAb1 in Human Subjects

Background

A humanized antibody derived from Ab1 (humanized Ab1 or ALD518)containing the variable heavy and light sequences in SEQ ID NO: 19 and20 was administered to rheumatoid arthritis patients. This antibody is ahumanized, asialated, IgG1 monoclonal antibody against IL-6 which hasbeen shown to have a half-life (t½) of approximately 30 days in humans.In studies in patients with RA, intravenous (IV) with this antibody(humanized Ab1) has demonstrated: efficacy over 16 weeks with rapidAmerican College of Rheumatology (ACR) responses; Complete and durablesuppression of C-reactive protein (CRP); Good tolerability, and a safetyprofile consistent with the biology of IL-6 blockade. This humanizedantibody binds to IL-6 with high affinity, preventing interaction andsignaling mediated via IL-6R. Rapid and significant treatment responseshave been demonstrated with intravenous (IV) administration of humanizedAb1 in patients with RA. In this example we study the safety,pharmacokinetics and pharmacodynamics of subcutaneous (SC)administration of humanized Ab1 in healthy subjects.

The objective of this study was to assess the safety, pharmacokinetics(PK) and pharmacodynamics (PD) of a single SC injection of thishumanized antibody in healthy male subjects.

Methods

In this Phase I, double-blind, placebo-controlled study, 27 subjectswere randomized 2:1 to receive a single dose of humanized Ab1 or placeboin the following groups: humanized Ab150 mg SC, humanized Ab1 100 mg SCor humanized Ab1100 mg IV (n=6 active and n=3 placebo per group). Theprimary objective was to assess safety of SC humanized Ab1 versusplacebo over 12 weeks. Plasma concentrations of humanized Ab1 and serumconcentrations of C-reactive protein (CRP) were assessed as secondaryobjectives. Assessments were performed daily in Week 1 and then on Day10, Weeks 2, 4, 6 and 8, and then monthly to Week 12. The study wasunblinded at Week 12, and humanized Ab1 subjects were monitored to Week24.

Study Design and Population

The study included 27 healthy male subjects (aged 18-65 years). Subjectswere dosed in three treatment groups of nine subjects each, randomized2:1 to receive a single dose of humanized Ab1 or placebo on Day 1.Humanized Ab1 treatments per group were: humanized Ab1 IV 100 mginfusion over 60 minutes; humanized Ab1 SC 50 mg injection (1 mL); orhumanized Ab1 100 mg injection (1 mL). The study was unblinded at Week12, after which placebo subjects discontinued the trial and ALD518subjects were monitored to Week 24.

Safety and Immunogenicity Assessments

The primary objective of the study was to assess the safety of SChumanized Ab1 compared with placebo over 12 weeks. Safety was monitoredover 12 weeks for all subjects. The study was unblinded at Week 12, andHumanized AB1 subjects were monitored to Week 24. Laboratory safetytests were performed pre-dose at screening and Day −1, and post dose onDays 2 and 7, Weeks 2, 4, 6, 8 and 12 for all subjects, and Weeks 16, 20and 24 post-dose for those randomized to Humanized Ab1. Anti-HumanizedAB1 antibodies were measured by enzyme-linked immunosorbent assay(ELISA). Blood samples were collected at Day 1 (pre-dose) and Week 12post-dose for all subjects, and Week 24 post-dose for those randomizedto Humanized Ab1.

Pharmacokinetic and Pharmacodynamic Assessments

Plasma Humanized AB1 and serum CRP concentrations were assessed byELISA. For all subjects, samples were collected at screening, pre-doseon Day 1, and post-dose on Days 2 and 7 and Weeks 2, 4, 6, 8 and 12. Forsubjects randomized to Humanized AB1, further samples were collected atWeeks 16, 20 and 24 post-dose.

Statistical Analysis

All subjects who received a dose of Humanized AB1 or placebo wereincluded in the safety analysis. All subjects who received a dose ofHumanized AB1 or placebo were included in PD and immunogenicityanalyses. All subjects who received a dose of Humanized AB1 wereincluded in PK analyses (n=18). All PK samples for placebo subjects wereconfirmed as below quantification. Descriptive statistics were generatedfor baseline demographics, safety data, plasma Humanized AB1 parametersand serum CRP concentrations. Wilcoxon Rank Sum test was used to compareCRP concentrations for Humanized AB1 treatments versus placebo.

Results—Summary

Over 24 weeks, there were no deaths or serious AEs, and no withdrawalsdue to AEs. Nearly all subjects (89%) experienced AEs, which were mildor moderate except one event of severe gastroenteritis in the Humanizedab1 SC 50 mg group. Injection site reactions occurred in 5/12 HumanizedAb1 SC subjects, 1/6 placebo SC subjects and 1/3 placebo IV subjects(none were reported in Humanized Ab1 IV subjects). These were mildexcept one case of moderate erythema and pruritis in the HumanizedAb1100 mg SC group. Increases in direct bilirubin and neutrophil countsbelow the limit of normal were more common in subjects receivingHumanized Ab1 than placebo; all were CTC Grade 1 or 2. The half life ofHumanized Ab1 was similar across all groups (mean range: 30.7-33.6days). The median Tmax of Humanized Ab1 was longer after SC (˜1 week)than after N administration (˜end of infusion). The PK of SC HumanizedAb1 was dose-proportional in terms of AUC and Cmax at doses of 50 mg and100 mg. Based on AUC0-∞ (day*μg/mL) of 237, 452 and 764 for theHumanized Ab150 mg SC, 100 mg SC and 100 mg N groups, respectively, thebioavailability of Humanized Ab1 was ˜60% for the SC versus IV groups.Subjects receiving Humanized Ab1 experienced rapid and sustainedreductions in serum CRP (FIG. 21A), similar results were seen when theantibody was administered either intravenous or subcutaneously (FIG.21B).

Subject Disposition and Baseline Demographics

A total of 27 subjects were enrolled and completed the study (n=18Humanized Ab1 and n=9 placebo). No subjects were withdrawn for anyreason. All subjects were male; 23/27 subjects were Caucasian and 4/27were Asian. Mean age was 29 (range 20-59) and was similar across thegroups. Mean height and weight were also generally comparable acrossgroups, although the IV placebo group were slightly lighter.

Safety and Immunogenicity to Week 12 for Humanized Ab1 and Placebo

A summary of safety is presented in TABLE 9. For the SC Humanized AB1groups, a total of 11/12 (91%) patients experienced an adverse event(AE) compared with: 6/6 (100%) for the N Humanized AB1 group; 4/6(66.6%) for the SC placebo group; and 3/3 (100%) for the IV placebogroup.

TABLE 14 Adverse Events Up to Week 12 Week 12-Week 24* SC 50 SC 100 IV100 Placebo Placebo SC 100 SC 100 IV 100 MedRA mg mg mg SC IV mg mg mgPreferred Term n = 6 n = 6 n = 6 n = 6 n = 6 n = 6 n = 6 n = 6 Subjectswith 6 5 6 4 3 3 5 5 an AE AE severity Mild 2 2 5 1 2 3 5 7 Moderate 3 31 3 1 1 1 0 Severe 1 0 0 0 0 0 0 0 Discontinuations 0 0 0 0 0 0 0 0 Dueto AEs Deaths 0 0 0 0 0 0 0 0 AEs reported in ≧2 subjects in any groupInjection site 1 2 0 0 0 0 0 0 erythema Injection site 1 2 0 0 1 0 0 0pruritis Gastroenteritis 1 0 2 0 0 0 0 0 URTI 4 4 4 2 2 0 1 2 Skinlaceration 2 1 2 0 0 0 0 0 Myalgia 0 0 0 2 0 0 0 0 Headache 5 2 1 1 0 01 1 Nasal 0 0 2 0 0 0 0 0 congestion *Patients randomized to placebo (IVor SC) discontinued at Week 12 and are not included in Week 24 analyses;AE = adverse event; SC = subcutaneous; IV = intravenous; URTI = upperrespiratory tract infection.

Across groups: No deaths or serious AEs were reported and there were nowithdrawals due to AEs. Most AEs were mild or moderate in intensity. Onecase of gastroenteritis in a SC Humanized AB1 50 mg subject wasconsidered severe, but not serious, and not related to study medication.No anti-Humanized AB1 antibodies were detected in any subject duringthis period.

Injection Site Reactions

Injection site reactions were reported in 26% (7/27) of subjects, andall occurred prior to Week 12 (TABLE 40). Injection site reactionsoccurred in 5/12 SC Humanized AB1 subjects and 1/6 SC placebo subjects.In the IV groups, 0/6 Humanized AB1 subjects and 1/3 placebo subjectsexperienced injection site reactions. All injection site reactions weremild except in one SC Humanized AB1 100 mg subject with moderateinjection site erythema and pruritis. No injection site reactionsoccurred after Week 12 in any of the Humanized AB1 groups. Infusion sitereactions were reported in 0/6 subjects receiving IV Humanized AB1 and1/3 IV placebo subjects (infusion site pruritis)

TABLE 15 Ab1 Injection Site Reactions to Week 12* Placebo Placebo 50 mg100 mg 100 mg SC IV n = 6 n = 6 n = 6 n = 6 n = 3 Total subjects with 23 0 1 1 injection site reaction Injection site erythema 1 2 0 0 0Injection site pain 1 1 0 1 0 Injection site pruritis 1 2 0 0 1Injection site rash 1 0 0 0 0 *All injection site reactions werereported in the first 12 weeks of the study. SC = subcutaneous; IV =intravenousClinical Laboratory Evaluations

TABLE 43 shows incidences of increased alanine aminotransferase (ALT)and aspartate aminotransferase (AST) and bilirubin levels across theHumanized AB1 and placebo groups. All ALT and AST levels were Grade 1 bythe Common Terminology Criteria for Adverse Events (CTCAE), and nolevels were ≧3 times the upper limit of normal (ULN). All increases intotal and direct bilirubin were CTCAE Grade 1 or 2 and no subject metcriteria for drug-induced liver damage. Only one subject (SC HumanizedAB1 100 mg group) had total bilirubin out of range (26 μmol/L, range0-24 μmol/L), at Week 24.

TABLE 16 Clinical Laboratory Evaluations Over 24 Weeks (Ab1) SC 50 mg SC100 mg IV 100 mg Placebo* n = 6 n = 6 n = 6 n = 9 Elevated ALT 0 1 3 2Elevated AST 0 1 1 1 Elevated total bilirubin 0 1 1 0 Elevated directbililrubin 2 4 5 2 Low neutrophil count^(†) 4 1 2 3 Low plateletcount^(†) 2 0 0 1 *SC and IV groups combined up to Week 12 only, afterwhich placebo-treated patients discontinued; ^(†)Below the lower limitof normal; SC = subcutaneous; IV = intravenous; ALT = alanineaminotransferase; AST = aspartate aminotransferase

Sporadic decreases in neutrophil and platelet counts were also observedin the Humanized AB1 and placebo groups. Neutrophil counts below thelower limit of normal were more common in subjects receiving HumanizedAB1 than placebo but all decreases were CTCAE Grade 1 or 2. Only onesubject (SC Humanized AB1 50 mg group) had consistent mild neutropeniato Week 24 (1.6×109/L at Week 24). Reductions in platelet counts wereall CTCAE Grade 1 (lowest level 134×109/L) and no subject had a lowplatelet count past Week 8.

Pharmacokinetics

Bioavailability of Humanized AB1 was 60% for SC Humanized AB1 50 and 100mg versus IV Humanized AB1 100 mg groups based on the mean AUC_(0-∞)(TABLE 44). The half-life of Humanized AB1 was similar across all groups(mean range: 30.7-33.6 days) (Table 17). Peak plasma concentration(C_(max)) of SC Humanized AB1 was reduced as compared to IV (FIG. 15).Median time to maximum plasma concentration (T_(max)) of Humanized Ab1was longer after SC Humanized AB1 (at approximately one week) than afterN Humanized Ab1 administration (at approximately the end of infusion).

TABLE 17 Ab1 Plasma Pharmacokinetic Parameters to Week 24 SC 50 mg SC100 mg IV 100 mg n = 6 n = 6 n = 6 C_(max) (μg/mL) (CV)* 5.57 (24%) 9.19(34%) 33.6 (30%) T_(max) (days) (min, max)^(†)   6 (6, 14)  5.5 (2, 28)0.17 (0, 17, 0.34) AUC₅₋₂₄ (day · μg/mL) (CV)*  218 (34%)  435 (19%) 732 (22%) AUC_(8-χ) (day · μg/mL) (CV)*  224 (39%)  444 (20%)  746(22%) t_(1/2) (days ± SD)^(‡) 33.6 ± 21.7 31.1 ± 9.0 30.7 ± 5.9 CL(mL/day) (CV)*  223 (32%)  225 (21%)  134 (27%) *Data are geometric mean(coefficient of variation %, CV %). ^(†)Data are median (minimum,maximum). ^(‡)Data are mean (±SD). CV = coefficient of variation;C_(max) = maximum plasma concentration; AUC = area under curve; SD =standard deviation; CL = apparent total body clearance for IV andapparent total body clearance divided by bioavailability for SC; IV =intravenous; SC = subcutaneous; T_(max) = time to maximum plasmaconcentration; t_(1/2) = terminal plasma half-lifePharmacodynamics

CRP levels were reduced in all subjects who received Humanized AB1irrespective of dose or administration route. From Weeks 4 to 12, CRPlevels were significantly lower in subjects who received Humanized Ab1compared with placebo (unadjusted p-value <0.05). A high correlationbetween the IgG produced and antigen specificity for an exemplary IL-6protocol was observed with 9 of 11 wells showed specific IgG correlationwith antigen recognition. In Humanized AB1 subjects, CRP levels werelowered to <20% of pre-dose levels in: 72% (13/18) of subjects at Week1; 73% (11/15) of subjects at Week 12; and 56% (10/18) of subjects atWeek 24.

Conclusions

In this Phase I study, the anti-IL-6 antibody Humanized Ab1 wasgenerally well tolerated when administered in a single SC dose inhealthy male subjects. Injection site reactions were generally mild. Noanti-Humanized Ab1 antibodies were detected. Changes in liver enzymes,neutrophil and platelet counts were reversible. The bioavailability ofSC Humanized AB1 was approximately 60% of that observed with IVHumanized Ab1. The half-life of Humanized AB1 was approximately 30 days,irrespective of route of administration. These data concur with previousdata using N Humanized Ab12. Subcutaneous Humanized AB1 led to rapid andlarge reductions in serum CRP. Reductions in CRP observed during thefirst 12 weeks of the study were sustained over 24 weeks of assessment.These preliminary data support the continued development and evaluationof subcutaneous Humanized Ab1 for the treatment of patients withmucositis.

In summary, in this Phase I study, the anti-IL-6 antibody Humanized Ab1was well tolerated when administered in a single SC dose; injection sitereactions were generally mild. The bioavailability of SC Humanized Ab1was ˜60% of N Humanized Ab1, and the half life was ˜30 days. Rapid andsignificant reductions in CRP were observed, which were sustained over24 weeks of assessment.

Example 36 Effect of Ab1 on DAS28-Assessed Disease Activity

ALD518* is an asialated, humanized anti-IL-6 monoclonal antibody with ahalf-life of ˜30 days containing the humanized variable heavy and lightsequences contained in SEQ ID NO:19 and 20. These humanized heavy andlight sequences are derived from a parent rabbit antibody thatspecifically binds human IL-6 which antibody is referred to in saidincorporated application as Ab1. ALD518 binds to IL-6 with highaffinity, preventing interaction and signalling mediated via soluble andmembrane-bound IL-6R. Rapid and significant ACR responses have beendemonstrated with ALD518* in patients with RA. In this example we reportthe impact of ALD518 on DAS28-assessed disease activity over 16 weeks.

Methods

Patients with active RA and an inadequate response to methotrexate (MTX)were randomized 1:1:1:1 to intravenous ALD518* 80, 160 or 320 mg orplacebo during this 16-week, double-blind, placebo-controlled Phase IIstudy. Patients received two IV infusions of ALD518 (Day 1 and Week 8),while continuing on stable doses of methotrexate (MTX). The primaryefficacy endpoint was the proportion of patients achieving ACR20 at Week12; disease activity was assessed via Disease Activity Score (DAS28)based on C-reactive protein (CRP) as a secondary endpoint. Theproportion of patients achieving DAS28-defined remission (score <2.6),low disease activity state (LDAS; score ≦3.2) and good EULAR responses(current DAS28≦3.2 and improvement from baseline >1.2) were assessed forthe modified intent-to-treat population, and are presented for patientswith available data (as observed). P-values are based on Chi-squaretests.

Results

Of 127 randomized and treated patients, 116 completed the trial. Atbaseline, mean age was 52.3 years and RA duration was 6.8 years. AtWeeks 4, 12 and 16, the proportion of patients achieving LDAS andremission was greater than placebo for all ALD518* doses; differenceswere significant versus placebo (p<0.05) for all assessments exceptALD518* 80 mg at Week 4 (p=0.056). Similarly, EULAR responses weresignificantly better for all ALD518* doses versus placebo (p<0.01) atWeeks 4, 12 and 16. There was a trend toward greater responses withhigher ALD518* doses.

TABLE 18 Proportion of patients achieving DAS28-defined remission, LDASand good EULAR responses ALD518* ALD518* ALD518* Placebo 80 mg 160 mg320 mg — (N = 32) (N = 34) (N = 28) (N = 33) DAS28-defined remissionWeek 4 10.0 8.8 17.9 0 Week 12 17.2 21.2 34.6 3.3 Week 16 13.8 28.1 44.00 LDAS Week 4 10.0 23.5 28.6 0 Week 12 20.6 33.3 46.1 6.6 Week 16 20.750.0 52.0 3.4 Good EULAR response Week 4 10.0 23.5 28.6 0 Week 12 20.733.3 46.2 6.7 Week 16 20.7 50.0 52.0 3.4 DAS28 = Disease Activity Score28; LDAS = low disease activity state

SAEs were reported in two ALD518 patients (both had significantincreases in liver enzymes, and discontinued treatment). Overall,elevations in liver enzymes >2×ULN occurred in 17% of ALD518*—versus 0%placebo-treated patients; the frequency was highest in the 320 mg dosegroup. Modest increases in total cholesterol were observed (meanincrease by Week 16=1.1 mmol/L for ALD518* versus 0.2 mmol/L forplacebo). Nine ALD518 patients had transient Grade II and two hadtransient Grade III neutropenias. There were no serious infections orinfusion reactions in any treatment group, and no evidentimmunogenicity.

Conclusions

In this Phase II study, the novel IL-6 inhibitor ALD518 resulted inrapid and significant improvements in disease activity sustained over 16weeks of assessment in patients with RA and an inadequate response tomethotrexate (MTX). ALD518 was well tolerated, with a safety profileconsistent with the biology of IL-6 blockade.

Example 37 Ab1 Administration

Methods

Patients with active RA were randomized into a 16 week, double-blind,placebo-controlled trial comparing multiple iv infusions of ALD518 (80,160 or 320 mg). Patients received an infusion every 8 weeks and weremaintained on a stable dose of MTX throughout the trial. Assessmentsincluded ACR 20/50/70 responses and DAS28. All patients were evaluatedfor safety. For early withdrawals, LOCF analysis was used for continuousvariables and non-responder imputation for categorical variables.

Results

132 patients were randomized; 127 were dosed. Mean disease duration was6.6 years; mean DAS28 score was 6.2 and mean HAQ-DI was 1.72. 11patients did not complete the 16-week trial: 320 mg-3, 160 mg-1, 80mg-3, placebo-4: 4 discontinued due to adverse events (80 mg-2, 320mg-2), with 2 SAEs (80 mg-1, 320 mg-1). Elevations in liver enzymes(LFTs) >2×ULN were observed in 17% ALD518 versus 0% placebo. There weremodest increases in total cholesterol (mean increase by week 16=1.1mmol/L ALD518 versus 0.2 mmol/L placebo). 9 patients on ALD518 hadtransient grade 2 neutropenias; 2 pts transient grade 3 neutropenias.There were no serious infections reported in any treatment group.Infusions of ALD518 were well tolerated without infusion reactions orevident immunogenicity. At weeks 4 and 16, ACR responses (non responderimputation analysis) and improvements in DAS28 scores were:

TABLE 19 Week 4 DAS28 Scores for Ab1 80, 160, and 320 dosages 80 mg 160mg 320 mg PBO + MTX Week 4 (n = 32) (n = 34) (n = 28) (n = 33) ACR20 50%(16)* 56% (19)* 71% (20)* 23% (8) ACR50  9% (3) 15% (5) 29% (8)†  3% (1)ACR70  6% (2)  0% (0) 11% (3)  0% (0) Mean Δ DAS28 −1.8 −2.1 −2 −0.6*p£0.04; †p = 0.009

TABLE 20 Week 16 DAS28 Scores for Ab1 80, 160, and 320 dosages 80 mg 160mg 320 mg PBO + MTX Week 16 (n = 32) (n = 34) (n = 28) (n = 33) ACR2075% (24)* 65% (22)* 82% (23)* 36% (12) ACR50 41% (13)* 41% (14)* 50%(140* 15% (5) ACR70 22% (7)† 18% (6)‡ 43% (12)*  6% (2) Mean Δ DAS28−2.7 −2.7 −3.2 −1.1 *p£0.03 †p = 0.08 ‡p = 0.26Conclusion

ALD518 is the first mAb to IL-6, as opposed to an anti-IL-6 receptormAb, to show a significant, rapid and sustained improvement in diseaseactivity in RA. ALD518 in doses ranging from 80 to 320 mg given as 2 IVinfusions to pts with active RA was well tolerated with increases inLFTs and total cholesterol and transient neutropenia observed in somepatients. There were no infusion reactions associated withadministration of ALD518 and no detectible immunogenicity.

Example 38 Treatment of Oral Mucositis with Head and Neck CancerReceiving Concurrent Chemotherapy and Radiotherapy

Subjects suffering from oral mucositis with head and neck cancerreceiving concurrent chemotherapy and radiotherapy may receive a regimenof a 160 mg or 320 mg doses of a composition comprising a humanizedmonoclonal antibody that selectively binds IL-6.

Subjects will be assessed using tumor staging (standard TNM system)during the screening period, which may occur within 30 days prior toradiotherapy (RT) start. The RT treatment period will be approximately 7weeks, depending on the subject's prescribed radiation plan. Post-RTtreatment period visits will be at Weeks 1, 2, 3, and 4 following thetreatment period. Long term follow-up visits will occur at 3, 6, 9, and12 months following the end of RT to determine if there is an effect ofALD518 on the tumor response to CRT.

Subjects may have recently diagnosed, pathologically confirmed,non-metastatic SCC of the oral cavity, oropharynx, hypopharynx orlarynx. Subjects may be scheduled to receive a continuous course ofintensity-modulated radiotherapy (IMRT), with a minimum cumulative doseof 55 Gy and maximum dose of 72 Gy. Planned radiation treatment fieldsmay include at least 2 oral sites (e.g., buccal mucosa, floor of oralcavity, tongue or soft palate) with each site receiving a total dose of≧55 Gy. The treatment plan may include monotherapy with cisplatinadministered in standard weekly (30 to 40 mg/m²) or tri-weekly (80 to100 mg/m², given on Days 0, 21 and 42) regimens or monotherapy withcarboplatin administered weekly (100 mg/m²).

A composition comprising a humanized monoclonal antibody thatselectively binds IL-6 may be given within 2 hours prior to thesubjects' radiation every 4 weeks for a total of 2 doses. A baselinevisit will occur on the first day of ALD518 and RT. Safety, PK, PD, andmarkers of IL-6 biology (e.g., total IL-6, sIL-6r, soluble gp130, sIL-6Complex) will be monitored during the RT treatment and Post-RT treatmentperiod. The long term follow-up period of the treatment may include longterm follow-up visits, primarily for the assessment of tumor responseand survival. These assessments will take place at Months 3, 6, 9 and 12following the last dose of RT. At Months 3, 6, 9, and 12 tumors will beassessed clinically. At the Month 6 and Month 12 follow-up visits, tumorstatus will be assessed using RECIST criteria and the same imagingmodality (CAT, PET or MRI) that was used to evaluate tumor status priorto RT start (at the time of staging) may be used.

Following a treatment regimen comprising the administration of ahumanized monoclonal antibody that selectively binds IL-6, patients mayshow improvement in their oral mucositis (e.g., a reduction insymptoms).

Example 39 Oral Mucositis Study 1: Single Acute Radiation Dose (40 Gy)Study

Introduction:

The efficacy of treatment with a rodent anti-IL-6 antibody (monoclonalrat IgG1 clone MP5-20F3, R&D Systems) was studied in an establishedmouse model of radiation-induced oral mucositis. Dorr & Kummermehr(1991) Virchows Arch B Cell Pathol Incl Mol Pathol 60(5): 287-94. Studyendpoints included oral mucositis duration and severity, body weight,and survival in normal C3H mice.

Methods:

36 male C3H mice were exposed to a single dose of 40 Gy radiationdirected to the underside of the tongue on Day 0. Animals were dosedwith a rodent anti-IL-6 antibody (monoclonal rat IgG1 clone MP5-20F3,R&D Systems), control antibody (monoclonal rat IgG1 clone 43414, R&DSystems), or vehicle on Days −1, 2, 6, 9, and 13, via intravenousinjection at 10 mg/kg into the tail vein. Animals were weighed daily,and food and water consumption were monitored in each treatment group.

Images of the tongue were captured daily from Days 4 to 16. An oralmucositis score was assigned to each animal based on a defined scoringscale per protocol design. The scoring scale is presented in Table 21.Following completion of the study, the tongue images were scored byblinded observers to establish the values used to determine the degreeand duration of oral mucositis and any treatment effects. A score of 1-2is considered to represent a mild stage of disease, whereas a score of3-5 is considered to indicate moderate to severe mucositis.

TABLE 21 Rodent Model Oral Mucositis Scoring Scale Score Description 0Tongue completely healthy. No erythema or vasodilation. 1 Light tosevere erythema and vasodilation. No erosion of mucosa. 2 Severeerythema and vasodilation. Erosion of superficial aspects of mucosaleaving denuded areas. Decreased stippling of mucosa. 3 Formation ofoff-white ulcers in at least one places. Ulcers may have a yellow/grayappearance due to pseudomembrane. Cumulative size of ulcers should equalabout ¼ of the tongue. Severe erythema and vasodilation. 4 Cumulativesize of ulcers should equal ¼ to ½ of the tongue. Loss of pliability.Severe erythema and vasodilation. 5 Virtually all of tongue isulcerated.

Results:

The onset of mucositis was the same for all 3 groups with peak mucositisscores occurring on Day 10. An analysis of the number of days micepresented with scores of 3+ during the study demonstrated no statisticaldifference among the 3 groups (mean days of 3.3, 4 and 3.6 for vehicle,isotype control and anti-IL-6, respectively).

On Day 10, 100% of the mice in the vehicle and control antibody groupsdeveloped ulcers while 67% of the anti-IL-6 group developed ulcers (FIG.22). There was no statistical difference in ulceration scores at Day 10between the anti-IL-6 antibody and control antibody or vehicle groups.On Days 12 and 13, a numerically larger (not statistically different)number of mice in the anti-IL-6 group had ulceration compared to themice in the vehicle or control groups.

Weight loss was seen in all 3 groups with peak weight loss occurringbetween Days 11 and 12. There were no statistically significantdifferences in weight change between the three groups. No generaltoxicities were noted in this study that could be attributed totreatment with the control or anti-IL-6 antibodies or the vehicle. Notreatment-related deaths occurred during the study.

Example 40 Ascending Radiation Dose Levels Study in Mouse Model ofRadition-Induced Oral Mucositis

Introduction

The efficacy of treatment with a rodent anti-IL-6 antibody (monoclonalrat IgG1 clone MP5-20F3, R&D Systems) was studied in an establishedmouse model of radiation-induced oral mucositis. Dorr & Kummermehr J.Proliferation kinetics of mouse tongue epithelium under normalconditions and following single dose irradiation. Virchows (1991) Arch BCell Pathol Incl Mol Pathol. 60(5): 287-294. Study endpoints includedoral mucositis duration and severity, body weight, and survival innormal C3H mice.

Methods

120 male C3H mice (12 per treatment group per radiation dose) wereexposed to a single dose of radiation, totaling 25, 30, 35, 40, or 45 Gydirected to the underside of the tongue on Day 0. Animals were dosedwith a rodent anti-IL-6 antibody (monoclonal rat IgG1 clone MP5-20F3,R&D Systems) or control antibody (monoclonal rat IgG1 clone 42414, R&DSystems) on Days −1, 2, 6, 9, and 13, via intravenous injection at 10mg/kg into the tail vein. Animals were weighed daily; and food and waterconsumption was monitored in each treatment group.

Images of the tongue were captured daily from Days 4 to 16. An oralmucositis score was assigned to each animal based on a defined scoringscale per protocol design. The scoring scale is presented in Table 21.Following completion of the study, the tongue images were scored byblinded observers to establish the values used to determine the degreeand duration of oral mucositis and any treatment effects. A score of 1-2is considered to represent a mild stage of disease, whereas a score of3-5 is considered to indicate moderate to severe mucositis.

Conclusions

Mice treated with the anti-IL-6 antibody at 25 Gy showed a statisticallysignificant decrease in the median number of days with ulcerationcompared to mice treated with the control antibody (p=0.0134). There wasno difference between the treatment groups at 30 and 35 Gy. Mice treatedwith the anti-IL-6 antibody at 40 and 45 Gy showed a statisticallysignificant increase in the median number of days with ulcerationcompared to mice treated with the control antibody (p=0.0237 and 0.0037,respectively). These data are shown in FIG. 23.

The anti-IL-6 treated group had a numerically lower percentage of micethat were ulcerated at any timepoint over the course of the studycompared to control antibody treated group at the 25 and 30 Gy radiationlevels (45% vs. 82%; 67% vs. 92%). See FIG. 24. At higher radiation doselevels the percentage of mice that were ulcerated over the course of thestudy in the two treatment groups were similar.

Over the course of the study, the anti-IL-6 treatment group receiving 25Gy had statistically significant positive median percentage changes frombaseline body weight compared to the control antibody group at alltimepoints. Additionally, at Day 4, the anti-IL-6 group at 30 and 35 Gyradiation dose levels had statistically significant positive medianpercentage changes from baseline body weight compared to the controlantibody group. At the 40 and 45 Gy radiation dose levels, there were nodifferences in median percent change from baseline between the anti-IL-6and control antibody groups.

No general toxicities were noted in this study that could be attributedto treatment with the anti-IL-6 antibody or control antibody. Notreatment-related deaths were observed during the study.

Conclusions

In conclusion, at the lowest dose (25 Gy) of radiation there was a lowerincidence and duration of ulcerated oral mucositis (scores 3-5) in theanti-IL-6 treated group compared to controls. Additionally, the micetreated with the anti-IL-6 antibody did not lose body weight compared tocontrols. At the 30 Gy radiation dose level, there was lower incidenceof ulcerated oral mucositis in the anti-IL-6 treated group compared tocontrols. Mice receiving higher single doses of radiation (40 Gy and 45Gy) had a longer duration of ulcerated oral mucositis in the anti-IL-6antibody treated group compared to controls. The radiation dose levelsadministered as single doses in this study are much higher than thedaily doses (approximately 2 Gy) given in TMRT for the treatment of headand neck cancer. These data support with the use of a humanizedmonoclonal antibody (e.g., ALD518) in the prevention of CRT-induced oralmucositis in head and neck cancer patients.

Example 41 Effect of Anti-IL-6 Treatment on Tumor Growth in a XenograftModel

Introduction

The human pharynx squamous cell carcinoma cell line (FaDu) has beenutilized as a model for head and neck cancers in mouse xenograftstudies. Alderson, et al (2002) Cancer Chemother. Pharmacol. 50:202-212. FaDu expresses both IL-6 and the IL-6 receptor and IL-6 levelsare induced in response to radiation treatment. Chen, et al. (2010) Int.J. Radiation Oncology Biol. Phys. 76:1214-1224 The effect of anti-IL-6treatment on the growth of FaDu tumors in the presence or absence ofradiation treatment was studied in an established mouse xenograft model.Study endpoints included tumor volume and body weights.

Methods

120, six week old, female athymic nude mice were implanted with tenmillion FaDu tumor cells subcutaneously. When tumors reached the weightrange of 125-250 mg (Day 10), animals were divided into 3 groups of 40mice. One group was given vehicle twice weekly via intravenous injectioninto the tail vein. The second group was given 10 mg/kg each of ALD518and an anti-mouse IL-6 antibody (monoclonal rat IgG1, R&D Systems). Thethird treatment group was given 10 mg/kg each of isotype controlantibodies (monoclonal human IgG1, R&D Systems). In each of thetreatment groups, half of the animals (N=20) were irradiated with 2Gy/day for 5 days and the other 20 animals were not irradiated. Animalswere euthanized when tumor volume reached 4,000 mm³ or ulceration of thetumor occurred. All animals were weighed and tumor volumes measuredthree times a week for the duration of the study.

Results

The tumor volumes for each animal were measured three times a weekstarting on the first day of treatment (Day 10). The study was completedon Day 29. FaDu tumors have a high rate of ulceration; in this study,between 9 and 13 animals were sacrificed in each group by Day 29 due totumor ulceration. No animals were euthanized due to tumor burden. Themedian tumor volume for each group is presented in FIG. 25. All groupshad median tumor volumes between 162-167 mm³ at the start of treatment(Day 10). Groups treated with vehicle, isotype control antibodies oranti-IL-6 antibodies but not irradiated displayed very similar mediantumor volumes throughout the study. These groups were not statisticallydifferent. Groups treated with vehicle, isotype control antibodies oranti-IL-6 antibodies plus radiation had reduced median tumor volumes ofroughly 50% compared to the non-irradiated groups post Day 22. Mediantumor volumes of the irradiated groups were similar and notstatistically different. Thus, treatment with anti-IL-6 antibodies hadno effect on tumor growth in either the non-irradiated or irradiatedgroups.

Additional conclusions from the study include: no differences in weightwere observed between the six groups; no general toxicities were notedthat could be attributed to treatment with the vehicle, controlantibodies or anti-IL-6 antibodies; and there were no treatment-relateddeaths.

Example 43 Clinical Trial Design

A phase 2, double-blind, placebo-controlled trial evaluating the safety,efficacy, pharmacokinetics and pharmacodynamics of ALD518, and thehealth and economic outcomes in subjects receiving CRT for the treatmentof squamous cell carcinomas (SCCs) of the oral cavity, oropharynx,hypopharynx or larynx may be conducted. Up to 96 subjects may beenrolled into this trial. Initially 3 open-label subjects will beenrolled into a safety run-in of the 160 mg dose. Approximately 90subjects will be randomized (1:1:1) into 1 of 2 dose levels of ALD518(160 mg and 320 mg) or placebo during the double-blind portion of thetrial. Safety, PK, PD, and markers of IL-6 biology (e.g., total IL-6,sIL-6r, soluble gp130, sIL-6 Complex) will be monitored during the RTtreatment and Post-RT treatment period. Additionally, exploratoryanalyses of IL-6 biology including cytokine biomarkers may be performedin a subset of subjects and will require separate consent.

Subject eligibility, including tumor staging (standard TNM system), willbe assessed during the screening period, which may occur within 30 daysprior to radiotherapy (RT) start. The RT treatment period will beapproximately 7 weeks, depending on the subject's prescribed radiationplan, Post-RT follow-up visits will be at Weeks 1, 2, 3, and 4. Longterm follow-up visits will occur at 3, 6, 9, and 12 months following theend of RT to determine if there is an effect of ALD518 on the tumorresponse to CRT.

Eligible subjects will have recently diagnosed, pathologicallyconfirmed, non-metastatic SCC of the oral cavity, oropharynx,hypopharynx or larynx. Subjects must be scheduled to receive acontinuous course of intensity-modulated radiotherapy (IMRT), with aminimum cumulative dose of 55 Gy and maximum dose of 72 Gy. Plannedradiation treatment fields must include at least 2 oral sites (e.g.,buccal mucosa, floor of oral cavity, tongue or soft palate) with eachsite receiving a total dose of ≧55 Gy. The treatment plan must includemonotherapy with cisplatin administered in standard weekly (30 to 40mg/m²) or tri-weekly (80 to 100 mg/m², given on Days 0, 21 and 42)regimens or monotherapy with carboplatin administered weekly (100mg/m²).

ALD518 or placebo will be given every 4 weeks within 2 hours prior tothe subjects' radiation for a total of 2 doses. A baseline visit willoccur on the first day of RT. During the RT treatment period, subjectswill be assessed twice weekly for the presence and severity of OM bytreatment-blinded, trained evaluators using the World HealthOrganization (WHO) grading scale for OM. Subjects will also complete adaily diary, containing the Oral Mucositis Daily Questionnaire (OMDQ)and a listing of analgesic use, and on a weekly basis the FACT-HN andFACIT-F subscale PRO instruments.

All subjects will return to the clinic for 4 weekly visits after RTcompletion for assessment of OM. During this time, subjects will alsocontinue to complete the OMDQ and the FACT-HN and FACIT-F subscale PROinstruments. The long term follow-up period of the clinical trial willinclude quarterly visits, primarily for the assessment of tumorresponse. These assessments will take place at Months 3, 6, 9 and 12following the last dose of RT. At Months 3, 6, 9, and 12 tumors will beassessed clinically. At the Month 6 and Month 12 follow-up visits, tumorstatus will be assessed using RECIST criteria and the same imagingmodality (CAT, PET, or MRI) that was used to evaluate tumor status priorto RT start (at the time of staging).

Example 44 Additional Evaluation of ALD518 in RA Clinical Trials

This example describes further Phase II clinical trial results foradministration of ALD518 to patients with active RA. For purposes ofinclusion in this study, a patient was considered to have active RA ifthe patient exhibited at least 6 swollen/6 tender joints, CRP ≧10 mg/dL,and had been treated with a stable dose of methotrexate (MTX) (>10mg/week) for at least 3 months and stable use of NSAIDs or steroids (ifany).

ALD518 was administered in a double-blind, placebo-controlled study inwhich patients with active RA were randomized 1:1:1:1 to receive either80 mg (n=32), 160 mg (n=34), or 320 mg (n=28) ALD518, or placebo (n=33).ALD518 or placebo were given as an intravenous infusion over 60 minuteson Day 1 and then again 8 weeks later. Patients were maintained onstable doses of methotrexate (MTX) (at least 10 mg/week).Disease-modifying antirheumatic drugs (DMARDs) other than MTX werediscontinued at least 4 months prior to study entry. Efficacy endpointswere assessed at weeks 12 (primary endpoint) and week 16. HRQoL wasevaluated by the Medical Outcomes Survey Short Form-36 (SF-36). Analyseswere performed on the modified intent-to-treat population for patientswith data available at the visit of interest (as observed).

127 active RA patients were randomized and treated, and 116 completedthe trial (80 mg, 29/32; 160 mg, 33/34; 320 mg, 25/28; placebo, 29/33).Patient disposition is summarized in FIG. 26.

At baseline, mean age was 52.3 years; mean RA duration was 6.8 years;mean tender and swollen joint counts were 26.1 and 16.7, and meanPhysical (PCS) and Mental component summary (MCS) scores were 31.0 and35.0, respectively. Mean changes from baseline to week 12 in MCS weresignificantly greater in each ALD518 dose group vs placebo, and meanchanges in both PCS and MCS scores exceeded MCID in each ALD518 group.At week 12, mean changes from baseline in one or more SF-36 domains weresignificantly greater in ALD518 dose groups vs placebo. Changes >MCIDwere observed in all domains and in SF-6D in patients receiving ALD518.Improvements at week 12 were sustained at week 16.

Results

Short Form-36 Component Summary Scores:

HRQoL was assessed by the patient-reported Short Form-36 (SF-36)questionnaire. The SF-36 includes 36 questions divided into eightdomains and summarized into the physical and mental component summaryscores (PCS and MCS, respectively). Scores range from 0 to 100, withhigher scores indicating better health. The observed Minimum ClinicallyImportant Differences (MCID) are 2.5-5.0 for the PCS and MCS, and5.0-10.0 for domain scores.

Short Form-6D:

The SF-6D is a validated preference-based measure of health utilities.The SF-6D was calculated using mean changes within treatment groupsacross all eight SF-36 domains to yield a single utility measure. TheMinimum Important Difference (MID) is 0.041.

Analysis

Analysis was performed on the modified intent-to-treat population forpatients with available data at the visit of interest (as observed).Changes from baseline in SF-36 PCS, MCS and domain scores weresummarized as descriptive statistics by treatment group and visit.ALD518 treatment groups were also compared with placebo at Week 12 usinga two-sample t-test.

For Weeks 12 and 16, spydergrams were used to present results across alldomains of the SF-36 in a single figure, and to compare with age- andgender-matched normative data from a US population. Demarcations alongthe domain axes of the spydergrams represent changes of 10 in domainscore, and patient disposition and baseline demographics andcharacteristics.

As shown in FIG. 26, a total of 127 patients were randomized andreceived ≧1 dose of ALD518; 91.3% of patients completed the study andeleven (8.7%) patients discontinued the study.

The individual SF-36 domain scores at Baseline and Week 12 are shown inTable 22 and illustrated graphically in FIG. 27. Baseline domain scoreswere generally well balanced across the treatment groups At baseline,patients had impaired HRQoL. Combined mean baseline PCS and MCS scoreswere 31.0 and 35.0, respectively, and 1.5-2.0 standard deviations lessthan normative values of 50. Scores for each of the individual subscalesof the SF-36 were also considerably lower than age- and gender-matchedUS norms.

For all ALD518 treatment groups, mean improvements from baseline to Week12 were large across the eight domains of the SF-36 and exceeded thoseobserved with placebo (See the Table 22 and FIG. 27). Mean improvementswere significantly greater than those observed with placebo (p<0.05;Table 22) at Week 12 in the following domains; Role physical (ALD518 320mg group); bodily pain, general health, social functioning and mentalhealth (ALP518 80 and 320 mg treatment groups); vitality (all ALD518groups); role emotional (ALD518 80 mg group).

At all doses of ALD518, mean improvements in all eight SF-36 domainsexceeded the MCID at Week 12. See Table 22. After adjustment for thechange from baseline in the placebo group, improvements from baselineobserved with ALD518 were greater than, and in some cases at leasttwice, that observed in the placebo group. There was observeddose-dependent changes (improvements) in the domains of role physical,bodily pain and mental health. Treatment with ALD518 resulted inimprovements in SF-36 scores toward those observed in the ‘normal’comparative population. See FIG. 29.

TABLE 22 SF-36 PCS and MCS Domains at Baseline and at Week 12 ALD518ALD518 ALD518 Domain* 80 mg 160 mg 320 mg Placebo (+age/gender norm)Time point (n = 32) (n = 34) (n = 28) (n = 33) PCS Domains Physicalfunctioning Baseline 48.3 42.1 49.3 42.8 (79.6) Mean at Week 12 61.061.6 70.4 55.0 Role physical (80.1) Baseline 27.9 26.0 36.7 33.5 Mean atWeek 12 50.0 53.5 59.7† 47.1 Bodily pain (68.3) Baseline 26.4 22.1 33.630.7 Mean at Week 12 47.8† 50.5 56.9† 39.5 General health Baseline 36.533.4 38.7 38.9 (69.5) Mean at Week 12 45.1† 45.6 49.5† 39.4 Vitality(58.2) Baseline 32.5 26.2 38.8 41.5 Mean at Week 12 50.9† 50.8† 60.9†46.3 Social functioning Baseline 47.7 31.6 42.1 48.8 (83.6) Mean at Week12 66.8† 59.4 73.1† 57.5 Role emotional Baseline 44.5 40.8 37.3 43.1(86.8) Mean at Week 12 60.3† 63.0 61.7 51.9 Mental health (74.9)Baseline 48.4 34.7 51.1 52.7 Mean at Week 12 61.0† 61.6 70.4† 55.0*0-100 scores are presented for each domain to enable interpretationwithin the context of the MCIDs; shading highlights changes ≧MCID indomain scores; Baseline scores are mean, based on patients withavailable data at visit of interest; PCS = Physical Component Score; MCS= Mental Component Score; MCID = Minimum Clinically ImportantDifferences; †represents p < 0.05 associated with comparison of changesfrom baseline between a ALD518 arm versus placebo based on an ANCOVAmodel, adjusted for age at baseline and sex

Result Summary: 127 active RA patients were randomized and treated, and116 completed the trial (80 mg, 29/32; 160 mg, 33/34; 320 mg, 25/28;placebo, 29/33). At baseline, mean age was 52.3 years; mean RA durationwas 6.8 years; mean tender and swollen joint counts were 26.1 and 16.7,and mean Physical (PCS) and Mental component summary (MCS) scores were31.0 and 35.0, respectively. Mean changes from baseline to week 12 inMCS were significantly greater in each ALD518 dose group vs placebo, andmean changes in both PCS and MCS scores exceeded MCID in each ALD518group. At week 12, mean changes from baseline in one or more SF-36domains were significantly greater in ALD518 dose groups than theplacebo group (Table 23). Improvements in SF-6D were 3-4 times the MIDin the ALD-518 groups compared with less than 2 times the MID in theplacebo group (as noted above, the MID is 0.041). Changes exceeding theMCID were observed in all domains and in SF-6D in patients receivingALD518. Improvements at week 12 were sustained at week 16.

TABLE 23 SF-6D Scores at Baseline and Weeks 12 and 16. ALD518 ALD518ALD518 SF-6D 80 mg 160 mg 320 mg Placebo (+age/gender norm) (n = 32) (n= 34) (n = 28) (n = 33) SF-6D Week 12 n = 32 33 29 32 (0.831) Baseline0.582 0.522 0.612 0.603 Mean at Week 12 0.714 0.715 0.785 0.664 Meanchange to Week 12 0.132 0.193 0.172 0.062 Week 16 n = 32 33 29 32Baseline 0.556 0.584 0.579 0.592 Mean at Week 16 0.692 0.736 0.751 0.662Mean change to Week 16 0.140 0.150 0.170 0.070 Shading highlightschanges that exceeded the MID (minimum important difference).

Conclusions:

Treatment with the IL-6 inhibitor ALD518 resulted in statisticallysignificant and clinically meaningful improvements in physical andmental aspects of HRQoL. These data further support the clinicalefficacy of ALD518 for treatment of patients with active RA andinadequate responses to methotrexate (MTX).

Example 45 Oral Mucositis Clinical Trial in Progress

Subjects suffering from oral mucositis with head and neck cancerreceiving concurrent chemotherapy and radiotherapy are being treatedwith regimen of a 160 mg doses of a composition comprising a humanizedmonoclonal antibody that selectively binds IL-6 (ALD518, also known asAb1 which contains the variable sequences in SEQ ID NO:19 and SEQ IDNO:20).

Subjects are being assessed using tumor staging (standard TNM system)during the screening period, which occurs within 30 days prior toradiotherapy (RT) start. The RT treatment period is approximately 7weeks, depending on the subject's prescribed radiation plan. Post-RTtreatment period visits are scheduled at weeks 1, 2, 3, and 4 followingthe treatment period. Long term follow-up visits are scheduled at 3, 6,9, and 12 months following the end of RT to determine if there is aneffect of ALD518 on the tumor response to CRT.

Subjects were recently diagnosed and pathologically confirmed withnon-metastatic SCC of the oral cavity, oropharynx, hypopharynx orlarynx. Subjects are scheduled to receive a continuous course ofintensity-modulated radiotherapy (IMRT) with a minimum cumulative doseof 55 Gy and maximum dose of 72 Gy. Planned radiation treatment fieldsinclude at least 2 oral sites (e.g., buccal mucosa, floor of oralcavity, tongue or soft palate) with each site receiving a total dose of≧55 Gy. The treatment plan include monotherapy with cisplatinadministered in standard weekly (30 to 40 mg/m²) or tri-weekly (80 to100 mg/m², given on Days 0, 21 and 42) regimens or monotherapy withcarboplatin administered weekly (100 mg/m²).

A composition comprising a humanized monoclonal antibody thatselectively binds IL-6 (ALD518 also known as Ab1) is being given within2 hours prior to the subjects' radiation every 4 weeks for a total of 2doses. A baseline visit occurred on the first day of ALD518 and RT.Safety, PK, PD, and markers of IL-6 biology (e.g., total IL-6, sIL-6r,soluble gp 130, sIL-6 Complex) are being monitored during the RTtreatment and Post-RT treatment period. The long term follow-up periodof the treatment includes scheduled long term follow-up visits,primarily for the assessment of tumor response and survival. Theseassessments are scheduled at months 3, 6, 9 and 12 following the lastdose of RT. At months 3, 6, 9, and 12 tumors will be assessedclinically. At the Month 6 and Month 12 follow-up visits, tumor statuswill be assessed using RECIST criteria and the same imaging modality(CAT, PET or MRI) that was used to evaluate tumor status prior to RTstart (at the time of staging) may be used.

Following a treatment regimen comprising the administration of ahumanized monoclonal antibody that selectively binds IL-6 ALD-518 (Ab1)the patients show improvement in their oral mucositis (e.g., a reductionin symptoms) after only 4 weeks of treatment.

As assessed using the WHO (World Health Organization) oral mucositisscale (Table 2) 3 patients receiving 160 mg intravenous administrationof ALD518 (Ab1) were assessed. The first subject (circles) has not shownany signs of developing oral mucositis, maintaining a Grade 0 for theentire 4 weeks. This is indicative of ALD518 acting to prevent thedevelopment of oral mucositis. The second patient (squares) developedGrade 2 oral mucositis, but this appears to have lessened in severity.This is indicative of ALD518 acting to prevent the development of severeoral mucositis (e.g., Grade 4) and even lessen the severity of oralmucositis. The third patient (triangles) developed Grade 2/3 oralmucosits. This is indicative of ALD518 acting to prevent the developmentof severe oral mucositis (e.g., Grade 4). In this patient population, itis expected that about 60% of patients to develop at least Grade 3 orGrade 4 oral mucositis with this type of IMRT+chemotherapy and over 80%of the patients to develop at least Grade 2 and above oral mucositis.Thus, this data suggests that a humanized monoclonal antibody thatselectively binds IL-6 (e.g., ALD518 also known as Ab1) is effective intreating and preventing oral mucositis resulting from the combination ofchemotherapy and radiotherapy.

We further conclude based on these results that other IL-6 antagonists,including those identified in this application, e.g., the exemplifiedanti-IL-6 antibodies and antibody fragments, as well as the identifiednon-antibody IL-6 antagonists, will have clinical application intreating and preventing mucositis, e.g., oral and gastrointestinal oralimentary mucositis.

Example 46 Ongoing Anemia Clinical Trial

Three cancer patients which were to be treated with cisplatin weretreated with ALD-518 prior to cisplatin chemotherapy in order to preventor lessen anemia, and in particular to prevent the onset of severeanemia which is a very common side effect of cisplatin therapy, i.e.,when administered alone or in conjunction with radiotherapy.

All three patients received cisplatin every 3 weeks at a dosage of 100mg/m². Particularly, said dosage of chemo was administered at week 0, atweek 3 and in one patient another dose was administered at week 6. Inthese same patients, 160 mg of ALD518 (Ab1), a humanized anti-IL-6monoclonal antibody containing the variable sequences in SEQ ID NO:19and SEQ ID NO:20, was administered intravenously at week 0 and week 4.Radiotherapy (RT) was also administered to these patients at a dosage of2-2.2 Gray per day from week 0 and will continue until the end of theplanned RT for each patient every day 5 days a week,

All 3 patients are now post-therapy (between week 8 and week 12 of thetreatment regimen). The last blood count was at the end of RT about week8. None of these patients as of week 8 after treatment shows signs ofsevere anemia. All three patients will be monitored at least until week12 and are expected to show no or less severe anemia resulting from thecombination of cisplatin and radiotherapy as compared to the severeanemia typically seen in patients receiving cisplatin alone or whenadministered in a clinical regimen also including radiation. This willbe confirmed by assaying hemoglobin and/or RBC counts and other clinicalindicators of anemia in these patients.

Although the invention has been described in some detail by way ofillustration and example for purposes of clarity of understanding, itwill be obvious that certain changes and modifications will practicedwithin the scope of the appended claims. Modifications of theabove-described modes for carrying out the invention that are obvious topersons of skill in medicine, pharmacology, microbiology, and/or relatedfields are intended to be within the scope of the following claims.

All publications (e.g., Non-Patent Literature), patent applicationpublications, and patent applications mentioned in this specificationare indicative of the level of skill of those skilled in the art towhich this invention pertains. All such publications (e.g., Non-PatentLiterature), patent application publications, and patent applicationsare herein incorporated by reference to the same extent as if eachindividual publication, patent, patent application publication, orpatent application is specifically and individually indicated to beincorporated by reference.

What we claim is:
 1. A method of treating or reducing the occurrence ofmucositis in a subject in need thereof, comprising administering acomposition comprising an effective amount of an anti-interleukin 1(IL-6) antibody or antibody fragment thereof that binds IL-6, whereinsaid antibody or antibody fragment thereof comprises the variable light(V_(L)) complementarity determining regions (CDRs) in SEQ ID NO:4, 5 and6, and the variable heavy (V_(H)) CDRs in SEQ ID NO:7, 8 or 120, and 9,respectively.
 2. The method of claim 1, wherein said mucositis is oralmucositis.
 3. The method of claim 1, wherein said mucositis isalimentary track mucositis.
 4. The method of claim 1, wherein saidmucositis is gastrointestinal tract mucositis.
 5. The method of claim 1,wherein said mucositis is mucositis associated with chemotherapy.
 6. Themethod of claim 5, wherein said chemotherapy comprises administration ofa chemotherapy agent selected from the group consisting of Alemtuzumab(Campath™), Asparaginase (Elspar™), Bleomycin (Blenoxane™), Busulfan(Myleran™, Busulfex™), Capecitabine (Xeloda™), Carboplatin(Paraplatin™), Cisplatin (PLATINOL™), Cyclophosphamide (Cytoxan™),Cytarabine (Cytosar-U™), Daunorubicin (Cerubidine™), Docetaxel(Taxotere™), Doxorubicin (Adriamycin™), Epirubicin (Ellence™), Etoposide(VePesid™), Fluorouracil (5-FU™), Gemcitabine (Gemzar™), Gemtuzumabozogamicin (Mylotarg™), Hydroxyurea (Hydrea™), Idarubicin (Idamycin™),Interleukin 2 (Proleukin™) Irinotecan (Camptosar™), Lomustine (CeeNU™),Mechlorethamine (Mustargen™), Melphalan (Alkeran™), Methotrexate(Rheumatrex™), Mitomycin (Mutamycin™), Mitoxantrone (Novantrone™),Oxaliplatin (Eloxatin™), Paclitaxel (Taxol™), Pemetrexed (Alimta™)Pentostatin (Nipent™), Procarbazine (Matulane™), Thiotepa (Thioplex™),Topotecan (Hycamtin™), Trastuzumab (Herceptin™), Tretinoin (Vesanoid™),Vinblastine (Velban™), and Vincristine (Oncovin™).
 7. The method ofclaim 1, wherein said mucositis is mucositis associated withradiotherapy.
 8. The method of claim 1, wherein said mucositis ismucositis associated with cancer.
 9. The method of claim 1, wherein saidmucositis is mucositis associated with hematopoietic stem celltransplant (HSCT).
 10. The method of claim 1, wherein said anti-IL-6antibody or antibody fragment thereof comprises at least one light chainselected from the group consisting of an amino acid sequence with atleast about 90% sequence identity to an amino acid sequence of SEQ IDNO: 2, 20, 647, 648, 649, 650, 651, 655, 660, 666, 667, 671, 675, 679,683, 687, 693, 699, 702, 706, or
 709. 11. The method of claim 1, whereinsaid anti-IL-6 antibody or antibody fragment thereof comprises at leastone heavy chain selected from the group consisting of an amino acidsequence with at least about 90% sequence identity to an amino acidsequence of SEQ ID NO: 3, 18, 19, 652, 653, 654, 655, 656, 657, 658,661, 664, 665, 668, 672, 676, 680, 684, 688, 691, 692, 704, or
 708. 12.The method of claim 1, wherein said antibody or antibody fragmentthereof comprises a light chain comprising the amino acid sequence ofSEQ ID NO: 2, 20, 647, 648, 649, 650, 651, 660, 666, 699, 702, 706, or709.
 13. The method of claim 1, wherein said antibody or antibodyfragment thereof comprises a humanized light chain comprising the aminoacid sequence of SEQ ID NO: 648, 649, or
 650. 14. The method of claim 1,wherein said antibody or antibody fragment thereof comprises a heavychain comprising the amino acid sequence of SEQ ID NO: 3, 18, 19, 652,653, 654, 655, 656, 657, 658, 661, 664, 665, 704, or
 708. 15. The methodof claim 1, wherein said antibody or antibody fragment thereof comprisesa humanized heavy chain comprising the amino acid sequence of SEQ ID NO:653, 654, or
 655. 16. The method of claim 1, wherein anti-IL-6 antibodyor antibody fragment thereof is expressed from a recombinant cell. 17.The method of claim 16, wherein the cell is mammalian, yeast, bacterial,or insect cell.
 18. The method of claim 17, wherein the cell is a yeastcell.
 19. The method of claim 18, wherein the cell is a diploidal yeastcell.
 20. The method of claim 19, wherein the yeast cell is a Pichiayeast.
 21. The method of claim 1, wherein said antibody or antibodyfragment thereof is asialated.
 22. The method of claim 1, wherein saidantibody fragment is a Fab, Fab′, F(ab′)₂, Fv, scFv, IgNAR, SMIP,camelbody, or nanobody.
 23. The method of claim 1, wherein said antibodyor antibody fragment thereof has an in vivo half-life of at least about30 days.
 24. The method of claim 1, wherein the antibody or antibodyfragment thereof is aglycosylated.
 25. The method of claim 1, whereinthe antibody or antibody fragment thereof contains an Fc region that hasbeen modified to alter effector function, half-life, proteolysis, and/orglycosylation.
 26. The method of claim 1, wherein the antibody orantibody fragment thereof is a human, humanized, single chain, orchimeric antibody.
 27. The method of claim 1, wherein the antibody orantibody fragment thereof further comprises a human F_(c).
 28. Themethod of claim 1, wherein said anti-IL-6 antibody or antibody fragmentthereof is administered prior to, concurrent with or after chemotherapyor radiotherapy.
 29. The method of claim 1, wherein said subject isreceiving concomitant chemotherapy.
 30. The method claim 1, wherein saidtreated mucositis comprises oral or oropharyngeal mucositis induced bychemoradiation (CRT) regimens or hematopoietic stem cell transplant(HSCT) used for the treatment of cancers of the head and neck.
 31. Amethod of treating or reducing the occurrence of emesis in a subject inneed thereof, comprising administering a composition comprising aneffective amount of an anti-interleukin 1 (IL-6) antibody or antibodyfragment thereof that binds IL-6, wherein said antibody or antibodyfragment thereof comprises the variable light (V_(L)) complementaritydetermining regions (CDRs) in SEQ ID NO:4, 5 and 6, and the variableheavy (V_(H)) CDRs in SEQ ID NO:7, 8 or 120, and 9, respectively. 32.The method of claim 31, wherein said emesis is emesis associated withchemotherapy.
 33. The method of claim 31, wherein said emesis is emesisassociated with radiotherapy.
 34. The method of claim 31, wherein saidemesis is emesis associated with hematopoietic stem cell transplant(HSCT).
 35. A method for treating oral mucositis in a subject with headand neck cancer receiving concomitant chemotherapy, comprisingadministering an effective amount of a humanized monoclonal antibodythat specifically binds interleukin-6 (IL-6), wherein said antibody orantibody fragment thereof comprises the variable light (V_(L)) CDRs inSEQ ID NO: 4, 5 and 6, and the variable heavy (V_(H)) CDRs in SEQ IDNO:7, 8 or 120, and 9, respectively.